Provider Demographics
NPI:1851790174
Name:HOFFMANN, ROLAND EDWARD
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:EDWARD
Last Name:HOFFMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 CLANCY RD
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-3241
Mailing Address - Country:US
Mailing Address - Phone:631-878-0421
Mailing Address - Fax:
Practice Address - Street 1:32 MILL RD
Practice Address - Street 2:STE. 4
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978-2311
Practice Address - Country:US
Practice Address - Phone:631-878-0421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-22
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098906-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker