Provider Demographics
NPI:1639481757
Name:ROFFERS, TONY (PHD)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:
Last Name:ROFFERS
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 1:3542 FRUITVALE AVE
Mailing Address - Street 2:#218
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-2327
Mailing Address - Country:US
Mailing Address - Phone:510-531-6730
Mailing Address - Fax:510-531-6730
Practice Address - Street 1:3978 FOREST HILL AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-2416
Practice Address - Country:US
Practice Address - Phone:510-531-6730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY3704103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist