Provider Demographics
NPI:1003838376
Name:TASOFF, ROBERT S (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:TASOFF
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 1:213 W ALAMEDA AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-2571
Mailing Address - Country:US
Mailing Address - Phone:818-567-2015
Mailing Address - Fax:818-348-8799
Practice Address - Street 1:213 W ALAMEDA AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2571
Practice Address - Country:US
Practice Address - Phone:818-567-2015
Practice Address - Fax:818-348-8799
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11047103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical