Healthcare Provider Details

I. General information

NPI: 1053982629
Provider Name (Legal Business Name): MATTHEW MASOUD GIVRAD PHD, PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 GREENBRIAR RD
GLENDALE CA
91207-1064
US

IV. Provider business mailing address

PO BOX 9097
GLENDALE CA
91226-0097
US

V. Phone/Fax

Practice location:
  • Phone: 626-786-0200
  • Fax:
Mailing address:
  • Phone: 626-786-0200
  • Fax: 818-240-4388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number32668
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number32668
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number32668
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number32668
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number32668
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: