Provider Demographics
NPI:1346341906
Name:HOFFMAN, MARY FRAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:FRAN
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:FRAN
Other - Middle Name:
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1455 S FORT THOMAS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-2453
Mailing Address - Country:US
Mailing Address - Phone:859-442-8439
Mailing Address - Fax:859-781-0123
Practice Address - Street 1:2865 CHANCELLOR DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3912
Practice Address - Country:US
Practice Address - Phone:859-442-8439
Practice Address - Fax:859-781-0123
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY720103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY204550492OtherTAX ID NUMBER