Provider Demographics
NPI:1992910194
Name:HOFFMAN, SUE ANN (MA)
Entity type:Individual
Prefix:MISS
First Name:SUE
Middle Name:ANN
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:ELYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17824-9690
Mailing Address - Country:US
Mailing Address - Phone:570-672-2260
Mailing Address - Fax:570-644-5396
Practice Address - Street 1:2000 NORTHWESTERN DR
Practice Address - Street 2:
Practice Address - City:COAL TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:17866-4167
Practice Address - Country:US
Practice Address - Phone:570-644-5350
Practice Address - Fax:570-644-5396
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006898-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist