Provider Demographics
NPI:1609900125
Name:MOFFIE, ROBERT W (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:MOFFIE
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 1:13100 VALLEYHEART DR
Mailing Address - Street 2:301
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-1959
Mailing Address - Country:US
Mailing Address - Phone:818-501-6844
Mailing Address - Fax:818-783-9254
Practice Address - Street 1:13100 VALLEYHEART DR
Practice Address - Street 2:301
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-1959
Practice Address - Country:US
Practice Address - Phone:818-501-6844
Practice Address - Fax:818-783-9254
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12704103TC0700X
AZ1874103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical