Provider Demographics
NPI:1063434355
Name:HOFFMAN, BEVERLY
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 SOUNDVIEW TER
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1230
Mailing Address - Country:US
Mailing Address - Phone:631-754-0094
Mailing Address - Fax:631-754-7013
Practice Address - Street 1:333 E 49TH ST
Practice Address - Street 2:SUITE LOBBY A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1680
Practice Address - Country:US
Practice Address - Phone:212-751-8020
Practice Address - Fax:631-754-7013
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0301281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4527337OtherAETNA ID
NY37344POtherHIP ID
NY136091POtherHIP ID
NY136091POtherHIP ID