Provider Demographics
NPI:1366512477
Name:MOHSEN, SHEREEN AMR (PSYD)
Entity type:Individual
Prefix:
First Name:SHEREEN
Middle Name:AMR
Last Name:MOHSEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S WINCHESTER BLVD STE J205
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3918
Mailing Address - Country:US
Mailing Address - Phone:408-680-4114
Mailing Address - Fax:
Practice Address - Street 1:1101 S WINCHESTER BLVD STE J205
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3918
Practice Address - Country:US
Practice Address - Phone:408-680-4114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPS2009129103T00000X
DC1000985103T00000X
CAPSY23831103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist