Provider Demographics
NPI:1124635339
Name:SPORER, ELIZABETH HOFFMAN
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:HOFFMAN
Last Name:SPORER
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 1:1318 MARLBOROUGH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-3215
Mailing Address - Country:US
Mailing Address - Phone:856-383-9914
Mailing Address - Fax:
Practice Address - Street 1:1318 MARLBOROUGH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-3215
Practice Address - Country:US
Practice Address - Phone:856-383-9914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA