Provider Demographics
NPI:1174657209
Name:MASSOUD, SOULAFA SHAKHSHIR (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SOULAFA
Middle Name:SHAKHSHIR
Last Name:MASSOUD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:SOULAFA
Other - Middle Name:O
Other - Last Name:SHAKHSHIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:308 E SAN JACINTO AVE
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92570-2878
Mailing Address - Country:US
Mailing Address - Phone:951-940-6810
Mailing Address - Fax:951-657-7146
Practice Address - Street 1:308 E SAN JACINTO AVE
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-2878
Practice Address - Country:US
Practice Address - Phone:951-940-6810
Practice Address - Fax:951-657-7146
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW664271041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33GX.FCOtherCOUNTY MENTAL HEALTH