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General NPI Number Information
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NPI Number | 1447579982
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Entity Type | Individual
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Provider Name | KATHIE H. MOFFITT PH.D
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Gender | Female
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Dates
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Enumeration Date | 05/24/2010
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Last Update Date | 06/30/2021
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Provider Practice Location Address
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Address Line | 148 EASTERN BLVD STE 306
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City | GLASTONBURY
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State | CT
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Zip | 06033-4321
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Country | US
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Telephone | 860-970-7782
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3028
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City | VERNON
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State | CT
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Zip | 06066-3028
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Country | US
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Telephone | 860-970-7782
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2984
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License Number State | CT
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