Provider Demographics
NPI:1790900207
Name:MOODY, ROBERT PATRICK (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PATRICK
Last Name:MOODY
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 1:303 DOWNEY AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-1203
Mailing Address - Country:US
Mailing Address - Phone:209-872-0331
Mailing Address - Fax:
Practice Address - Street 1:303 DOWNEY AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-1203
Practice Address - Country:US
Practice Address - Phone:209-577-2000
Practice Address - Fax:209-577-2000
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 10974103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
68-0594550OtherEIN