Provider Demographics
NPI:1053010371
Name:HOFFMAN, SHANI (LCSW)
Entity type:Individual
Prefix:
First Name:SHANI
Middle Name:
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 PONTE VEDRA LAKES BLVD APT 2306
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-1246
Mailing Address - Country:US
Mailing Address - Phone:904-800-8835
Mailing Address - Fax:
Practice Address - Street 1:611 PONTE VEDRA LAKES BLVD APT 2306
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-1246
Practice Address - Country:US
Practice Address - Phone:904-800-8835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-24
Last Update Date:2023-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL129771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical