Provider Demographics
NPI:1194762385
Name:HOFFMAN, CLYDE H (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:CLYDE
Middle Name:H
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 DONATION RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-1426
Mailing Address - Country:US
Mailing Address - Phone:724-588-8192
Mailing Address - Fax:
Practice Address - Street 1:2201 E STATE ST
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-2727
Practice Address - Country:US
Practice Address - Phone:724-981-7141
Practice Address - Fax:724-981-7148
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0137201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100000380Medicaid
PA058533F4RMedicare ID - Type UnspecifiedIN ASSOCIATION WITH CCC
PA100000380Medicaid