Provider Demographics
NPI:1184950511
Name:MOGHADAM, SEDDIGHEH SANDY (DMFT)
Entity type:Individual
Prefix:
First Name:SEDDIGHEH
Middle Name:SANDY
Last Name:MOGHADAM
Suffix:
Gender:F
Credentials:DMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 W. COAST HWY. PCH
Mailing Address - Street 2:SUITE 200 #283
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663
Mailing Address - Country:US
Mailing Address - Phone:949-258-4384
Mailing Address - Fax:
Practice Address - Street 1:2901 W. COAST HWY. PCH
Practice Address - Street 2:SUITE 200 #283
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663
Practice Address - Country:US
Practice Address - Phone:949-258-4384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 43612106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist