Healthcare Provider Details

I. General information

NPI: 1821925454
Provider Name (Legal Business Name): MOFFETT MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 RENDE LN
LAKE WORTH FL
33461-4962
US

IV. Provider business mailing address

4414 RENDE LN
LAKE WORTH FL
33461-4962
US

V. Phone/Fax

Practice location:
  • Phone: 561-646-2816
  • Fax:
Mailing address:
  • Phone: 561-646-2816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MAURICE MOFFETT V
Title or Position: OWNER
Credential: LCSW
Phone: 561-646-2816