Provider Demographics
NPI:1437314747
Name:HOFFMAN, MONIQUE (LMSW CC)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:LMSW CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 GANNETT DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106
Mailing Address - Country:US
Mailing Address - Phone:207-771-5700
Mailing Address - Fax:207-771-5755
Practice Address - Street 1:324 GANNETT DRIVE
Practice Address - Street 2:STE 300
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106
Practice Address - Country:US
Practice Address - Phone:207-771-5711
Practice Address - Fax:207-771-5755
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC 11259104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker