Provider Demographics
NPI:1881673697
Name:HOFFMAN, DIANA (MA)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 S IRVING AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-2024
Mailing Address - Country:US
Mailing Address - Phone:570-343-2755
Mailing Address - Fax:570-562-2435
Practice Address - Street 1:314 S IRVING AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-2024
Practice Address - Country:US
Practice Address - Phone:570-343-2755
Practice Address - Fax:570-562-2435
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006942L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAHIGHMARK BC BSOther579390
PALICENSEOtherPS006942L