Provider Demographics
NPI:1851591325
Name:HOFFORT, LISA MARLENE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARLENE
Last Name:HOFFORT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 E COLORADO BLVD
Mailing Address - Street 2:SUITE 610
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2053
Mailing Address - Country:US
Mailing Address - Phone:818-430-3054
Mailing Address - Fax:
Practice Address - Street 1:595 E COLORADO BLVD
Practice Address - Street 2:SUITE 610
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2053
Practice Address - Country:US
Practice Address - Phone:818-430-3054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21572103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical