Provider Demographics
NPI:1538644406
Name:SOROORY, SAMIRA (LMFT)
Entity Type:Individual
Prefix:MISS
First Name:SAMIRA
Middle Name:
Last Name:SOROORY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2173 SCHOLARSHIP
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-5662
Mailing Address - Country:US
Mailing Address - Phone:310-600-4027
Mailing Address - Fax:
Practice Address - Street 1:2152 DUPONT DR STE 174
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1315
Practice Address - Country:US
Practice Address - Phone:310-600-4027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT105808106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist