Provider Demographics
NPI:1710342126
Name:MOGHADDAM, MASOOD (MSW)
Entity Type:Individual
Prefix:MR
First Name:MASOOD
Middle Name:
Last Name:MOGHADDAM
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9435 JORNADA LN APT 6
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-5874
Mailing Address - Country:US
Mailing Address - Phone:415-902-1296
Mailing Address - Fax:
Practice Address - Street 1:5975 ENTRADA AVE UNIT 122
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-4223
Practice Address - Country:US
Practice Address - Phone:415-902-1296
Practice Address - Fax:805-466-9765
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-30
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW916891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical