Provider Demographics
NPI:1235580606
Name:KATHIE H. MOFFITT PHD
Entity type:Organization
Organization Name:KATHIE H. MOFFITT PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:MOFFITT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-970-7782
Mailing Address - Street 1:PO BOX 3028
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-1928
Mailing Address - Country:US
Mailing Address - Phone:860-970-7782
Mailing Address - Fax:860-812-2252
Practice Address - Street 1:148 EASTERN BLVD STE 306
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4321
Practice Address - Country:US
Practice Address - Phone:860-970-7782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2984103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty