Provider Demographics
NPI:1518555804
Name:SOROUSH, SHIRIN (MA, EDS)
Entity Type:Individual
Prefix:MRS
First Name:SHIRIN
Middle Name:
Last Name:SOROUSH
Suffix:
Gender:F
Credentials:MA, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SPRINGFIELD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-1939
Mailing Address - Country:US
Mailing Address - Phone:818-300-6365
Mailing Address - Fax:
Practice Address - Street 1:2 SPRINGFIELD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-1939
Practice Address - Country:US
Practice Address - Phone:818-300-6365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool