=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710371364
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBRA A. ANN HOFFMANN L.M.S.W
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2015
-----------------------------------------------------
Last Update Date | 03/22/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6708 64TH ST APT 2 LT
-----------------------------------------------------
City | RIDGEWOOD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11385-4632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-501-0799
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6708 64TH ST APT 2 LT
-----------------------------------------------------
City | RIDGEWOOD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11385-4632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-501-0799
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | # 091626-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------