Provider Demographics
NPI:1093922015
Name:MOFFITT, ROSEMARY ANN (MFT)
Entity Type:Individual
Prefix:MS
First Name:ROSEMARY
Middle Name:ANN
Last Name:MOFFITT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18741 HWY 9
Mailing Address - Street 2:
Mailing Address - City:BOULDER CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:95006-9057
Mailing Address - Country:US
Mailing Address - Phone:408-260-8866
Mailing Address - Fax:831-338-9291
Practice Address - Street 1:920 SARATOGA AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-0000
Practice Address - Country:US
Practice Address - Phone:408-260-8866
Practice Address - Fax:831-338-9291
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27979106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist