Provider Demographics
NPI:1417191107
Name:HOFRICHTER, ELIZABETH STEPHANIE (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:STEPHANIE
Last Name:HOFRICHTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11033 NW SR 20
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:FL
Mailing Address - Zip Code:32321
Mailing Address - Country:US
Mailing Address - Phone:850-643-1155
Mailing Address - Fax:850-643-1163
Practice Address - Street 1:11033 NW SR 20
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:FL
Practice Address - Zip Code:32321
Practice Address - Country:US
Practice Address - Phone:850-643-2292
Practice Address - Fax:850-643-1163
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW60341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW 6034OtherFLORIDA MEDICAL LICENSE