Provider Demographics
NPI:1295942175
Name:HOFFMAN, STANLEY C (PHD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:C
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 KILBOURN ST
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-1920
Mailing Address - Country:US
Mailing Address - Phone:574-294-6921
Mailing Address - Fax:574-266-8066
Practice Address - Street 1:1750 KILBOURN ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-1920
Practice Address - Country:US
Practice Address - Phone:574-294-6921
Practice Address - Fax:574-266-8066
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20010384103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN227290Medicare ID - Type Unspecified
IN000000214294Medicare UPIN