Provider Demographics
NPI:1891286449
Name:HOFFMAN, MELANIE DOREEN
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:DOREEN
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-2005
Mailing Address - Country:US
Mailing Address - Phone:719-948-7120
Mailing Address - Fax:719-298-7144
Practice Address - Street 1:327 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-2005
Practice Address - Country:US
Practice Address - Phone:719-948-7120
Practice Address - Fax:719-298-7144
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0004750103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist