Provider Demographics
NPI:1891988218
Name:HOFFMANN, SUSAN MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIE
Last Name:HOFFMANN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:MARIE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3355A JOHN TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAWN
Mailing Address - State:TN
Mailing Address - Zip Code:37191-9116
Mailing Address - Country:US
Mailing Address - Phone:931-237-5208
Mailing Address - Fax:
Practice Address - Street 1:3355A JOHN TAYLOR RD
Practice Address - Street 2:
Practice Address - City:WOODLAWN
Practice Address - State:TN
Practice Address - Zip Code:37191-9116
Practice Address - Country:US
Practice Address - Phone:931-237-5208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30604011Medicaid