Provider Demographics
NPI:1770505034
Name:HOFFMAN, PENNY DENISE (LCSW)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:DENISE
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1765 GOUCHER ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-1101
Mailing Address - Country:US
Mailing Address - Phone:814-535-8586
Mailing Address - Fax:814-254-4170
Practice Address - Street 1:1765 GOUCHER ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-1101
Practice Address - Country:US
Practice Address - Phone:814-535-8586
Practice Address - Fax:814-254-4170
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2018-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0195801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000001750065Medicaid
PA1000001750065Medicaid