Provider Demographics
NPI:1518992114
Name:KIAHASHEMI, MASOUMEH M (MFT)
Entity Type:Individual
Prefix:MRS
First Name:MASOUMEH
Middle Name:M
Last Name:KIAHASHEMI
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NEWPORT CENTER DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7501
Mailing Address - Country:US
Mailing Address - Phone:949-632-7468
Mailing Address - Fax:
Practice Address - Street 1:200 NEWPORT CENTER DR
Practice Address - Street 2:SUITE 202
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7501
Practice Address - Country:US
Practice Address - Phone:949-632-7468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36802106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist