Provider Demographics
NPI:1538494018
Name:MOFFA, MORGAN S
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:S
Last Name:MOFFA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 RIVERSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-4817
Mailing Address - Country:US
Mailing Address - Phone:401-864-1791
Mailing Address - Fax:
Practice Address - Street 1:201 RIVERSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-4817
Practice Address - Country:US
Practice Address - Phone:401-864-1791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health