Provider Demographics
NPI:1659700961
Name:MOHAGHEGH, SARA (LMFT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:MOHAGHEGH
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 1:596 SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-3052
Mailing Address - Country:US
Mailing Address - Phone:510-688-2353
Mailing Address - Fax:510-373-6282
Practice Address - Street 1:303 W JOAQUIN AVE STE 100A
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-3642
Practice Address - Country:US
Practice Address - Phone:510-688-2353
Practice Address - Fax:510-373-6282
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT104678106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist