Provider Demographics
NPI:1750641924
Name:HOFFMAN, ELIZABETH HODGE (LCSW, MED)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:HODGE
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:LCSW, MED
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:HODGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:1226 BROOKSTONE LN
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-2325
Mailing Address - Country:US
Mailing Address - Phone:636-561-2063
Mailing Address - Fax:
Practice Address - Street 1:332 STABLE LN
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385
Practice Address - Country:US
Practice Address - Phone:636-332-4940
Practice Address - Fax:636-332-4941
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010124761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1976GRADMedicaid
MO7777Medicaid