Provider Demographics
NPI:1558331686
Name:HOFFMAN, J SCHUYLER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:J SCHUYLER
Middle Name:
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3150
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01931-3150
Mailing Address - Country:US
Mailing Address - Phone:978-282-4669
Mailing Address - Fax:978-282-1620
Practice Address - Street 1:19 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-5937
Practice Address - Country:US
Practice Address - Phone:978-282-4669
Practice Address - Fax:978-282-1620
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4994103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1301489Medicaid