Provider Demographics
NPI:1538132295
Name:HOFFART, MARIE T (LISW)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:T
Last Name:HOFFART
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MRS
Other - First Name:MARIE
Other - Middle Name:T
Other - Last Name:HOFFART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISW
Mailing Address - Street 1:2344 BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:HINCKLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44233-9612
Mailing Address - Country:US
Mailing Address - Phone:440-237-2539
Mailing Address - Fax:440-846-0890
Practice Address - Street 1:12700 PEARL RD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-3422
Practice Address - Country:US
Practice Address - Phone:440-846-0862
Practice Address - Fax:440-846-0890
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 79701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7358388OtherAETNA PROVIDER NO.
OH171522OtherMHN PROVIDER
OH11509844OtherCAQH PROVIDER NO.
OH00 00 00 383 640OtherANTHEM PROVIDER NO.
OH0762278Medicaid
OHHOSW24511Medicare ID - Type UnspecifiedALTERNATIVE PATH PROVIDER