Provider Demographics
NPI:1972257871
Name:MOUSSAVY, MALLIKA (PSYD)
Entity type:Individual
Prefix:DR
First Name:MALLIKA
Middle Name:
Last Name:MOUSSAVY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MALLIKA
Other - Middle Name:
Other - Last Name:SAMAKAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:3855 LUNA CT
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-3865
Mailing Address - Country:US
Mailing Address - Phone:626-429-2931
Mailing Address - Fax:
Practice Address - Street 1:3855 LUNA CT
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-3865
Practice Address - Country:US
Practice Address - Phone:626-429-2931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30989103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist