Provider Demographics
NPI:1467789784
Name:HOFFMAN, GARY LEE (PHD)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:LEE
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 N DOUTY ST
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-3722
Mailing Address - Country:US
Mailing Address - Phone:559-537-0246
Mailing Address - Fax:559-589-2309
Practice Address - Street 1:1025 N DOUTY ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3722
Practice Address - Country:US
Practice Address - Phone:559-537-0246
Practice Address - Fax:559-589-2309
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16213103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist