Provider Demographics
NPI:1134230048
Name:MOFFETT, LOUIS ANDREW (PHD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:ANDREW
Last Name:MOFFETT
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 1:241 MCKENDRY DR
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-2917
Mailing Address - Country:US
Mailing Address - Phone:650-324-8570
Mailing Address - Fax:
Practice Address - Street 1:1050 UNIVERSITY DR
Practice Address - Street 2:200
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4636
Practice Address - Country:US
Practice Address - Phone:650-322-0704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4877103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical