Provider Demographics
NPI:1386387363
Name:MOHADDESS-WESTMORELAND, JUSTINE JESSA (MA)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:JESSA
Last Name:MOHADDESS-WESTMORELAND
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:JESSA
Other - Last Name:MOHADDESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1198 1685
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95812-1198
Mailing Address - Country:US
Mailing Address - Phone:916-601-6334
Mailing Address - Fax:
Practice Address - Street 1:1493 CAMBRIDGE ST RM 239
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1099
Practice Address - Country:US
Practice Address - Phone:617-575-5399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service