Provider Demographics
NPI:1669500385
Name:MOFFETT, DEBORAH LEE (PHD, PSYD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:LEE
Last Name:MOFFETT
Suffix:
Gender:F
Credentials:PHD, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4504
Mailing Address - Country:US
Mailing Address - Phone:805-346-1999
Mailing Address - Fax:805-346-1998
Practice Address - Street 1:518 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4504
Practice Address - Country:US
Practice Address - Phone:805-346-1999
Practice Address - Fax:805-346-1998
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20088103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP20088Medicare ID - Type Unspecified