Provider Demographics
NPI:1053612267
Name:MASROURI, NAHID (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:NAHID
Middle Name:
Last Name:MASROURI
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 DEMONG DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13214-1417
Mailing Address - Country:US
Mailing Address - Phone:818-568-9960
Mailing Address - Fax:315-326-0229
Practice Address - Street 1:105 CTY RTE 45 A SUITE 300
Practice Address - Street 2:OSWEGO HOSPITAL, CHILDREN'S SERVICES
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-6664
Practice Address - Country:US
Practice Address - Phone:315-326-0157
Practice Address - Fax:315-326-0229
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR04689-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical