Healthcare Provider Details

I. General information

NPI: 1396902953
Provider Name (Legal Business Name): STEPHEN M. HOFFMAN MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34700 VALLEY RD
OCONOMOWOC WI
53066-4500
US

IV. Provider business mailing address

34700 VALLEY RD
OCONOMOWOC WI
53066-4500
US

V. Phone/Fax

Practice location:
  • Phone: 262-646-1044
  • Fax:
Mailing address:
  • Phone: 262-646-1044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number7147-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: