Provider Demographics
NPI:1619065158
Name:HOFFMAN, MELISSA CAROL (LICSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:CAROL
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 5445
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5445
Mailing Address - Country:US
Mailing Address - Phone:425-252-3909
Mailing Address - Fax:
Practice Address - Street 1:2230 RUCKER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-2772
Practice Address - Country:US
Practice Address - Phone:425-252-3909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00004432101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8871466Medicare PIN
WAG8878216Medicare PIN