Provider Demographics
NPI:1235508896
Name:ROFF, ROBERT LEONARD (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEONARD
Last Name:ROFF
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 1:1404 BRADFORD LN
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-4855
Mailing Address - Country:US
Mailing Address - Phone:304-685-9387
Mailing Address - Fax:
Practice Address - Street 1:1404 BRADFORD LN
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-4855
Practice Address - Country:US
Practice Address - Phone:304-685-9387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV686103TC0700X
PAPS017871103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical