Provider Demographics
NPI:1710197645
Name:HOFFMAN, MICHAEL ROBERT (MSW, LCSW, LICSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROBERT
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:MSW, LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 NE FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4918
Mailing Address - Country:US
Mailing Address - Phone:541-639-6246
Mailing Address - Fax:
Practice Address - Street 1:300 SE REED MARKET RD
Practice Address - Street 2:STE 205
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2237
Practice Address - Country:US
Practice Address - Phone:541-639-6246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW601134651041C0700X
ORL60741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical