Provider Demographics
NPI:1275561995
Name:HOFFMAN, KATHLEEN MARY
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARY
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:MARY
Other - Last Name:WEEKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,MSN,CS
Mailing Address - Street 1:86 BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-1349
Mailing Address - Country:US
Mailing Address - Phone:508-251-0156
Mailing Address - Fax:508-303-0008
Practice Address - Street 1:86 BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-1349
Practice Address - Country:US
Practice Address - Phone:508-303-6500
Practice Address - Fax:508-303-0008
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA183925PC364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPN0246OtherBC/BS
MANS0270Medicare ID - Type Unspecified