Provider Demographics
NPI:1114391935
Name:HOSSEINI, SOHEILA (PHD)
Entity type:Individual
Prefix:DR
First Name:SOHEILA
Middle Name:
Last Name:HOSSEINI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 BROADWAY STE 200
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2330
Mailing Address - Country:US
Mailing Address - Phone:310-857-4946
Mailing Address - Fax:310-601-5193
Practice Address - Street 1:127 BROADWAY STE 200
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2330
Practice Address - Country:US
Practice Address - Phone:310-857-4946
Practice Address - Fax:310-601-5193
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-17
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29987103T00000X, 103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral