Provider Demographics
NPI:1376029413
Name:HOFFMAN, DESIRAE
Entity Type:Individual
Prefix:
First Name:DESIRAE
Middle Name:
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 AMES RD
Mailing Address - Street 2:
Mailing Address - City:BENTLEYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15314-1927
Mailing Address - Country:US
Mailing Address - Phone:814-233-8605
Mailing Address - Fax:
Practice Address - Street 1:3150 WASHINGTON RD STE 201
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-3189
Practice Address - Country:US
Practice Address - Phone:724-933-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst