Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 32668 | CA |
N | 103T00000X | Psychologist | 32668 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 32668 | CA |
Y | 103G00000X | Clinical Psychologist | 32668 | CA |
Y | 103TC0700X | Clinical Psychologist | 32668 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 32668 | CA |
N | 103TH0004X | Health Psychologist | 32668 | CA |
NPI | 1053982629 |
---|---|
Provider Name | Matthew Masoud Givrad |
First Address | Glendale, CA 91226-0097 |
Second Address | Glendale, CA 91207-1064 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2021 |
Last Update Date | 06/07/2021 |