Provider Demographics
NPI:1033276266
Name:HOFFMAN, BERNICE (PHD)
Entity Type:Individual
Prefix:
First Name:BERNICE
Middle Name:
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ONE HALF WEST 84TH ST
Mailing Address - Street 2:4A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024
Mailing Address - Country:US
Mailing Address - Phone:212-362-0047
Mailing Address - Fax:
Practice Address - Street 1:11 ONE HALF WEST 84TH ST
Practice Address - Street 2:4A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024
Practice Address - Country:US
Practice Address - Phone:212-362-0047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005351103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
027062OtherVALUE OPTIONS
NY01951808Medicaid
269141OtherMHN
269141OtherMHN