Provider Demographics
NPI:1114084530
Name:HOFFMAN, NANCY A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:A
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 LINCOLN AVE
Mailing Address - Street 2:SUITE 110B
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2120
Mailing Address - Country:US
Mailing Address - Phone:415-339-8616
Mailing Address - Fax:415-234-8088
Practice Address - Street 1:1330 LINCOLN AVE
Practice Address - Street 2:SUITE 110B
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2120
Practice Address - Country:US
Practice Address - Phone:415-339-8616
Practice Address - Fax:415-324-8088
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20516103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL205160Medicare UPIN