Healthcare Provider Details

I. General information

NPI: 1235508896
Provider Name (Legal Business Name): ROBERT LEONARD ROFF PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2015
Last Update Date: 09/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 BRADFORD LN
MORGANTOWN WV
26508-4855
US

IV. Provider business mailing address

1404 BRADFORD LN
MORGANTOWN WV
26508-4855
US

V. Phone/Fax

Practice location:
  • Phone: 304-685-9387
  • Fax:
Mailing address:
  • Phone: 304-685-9387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number686
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS017871
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: