Provider Demographics
NPI:1245916402
Name:AFSAR, MOHAMMAD KHAIRUL (LCSW)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:KHAIRUL
Last Name:AFSAR
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 JAMES M WOOD BLVD APT 420
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2218
Mailing Address - Country:US
Mailing Address - Phone:951-238-0664
Mailing Address - Fax:
Practice Address - Street 1:2121 JAMES M WOOD BLVD APT 420
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2218
Practice Address - Country:US
Practice Address - Phone:951-238-0664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2023-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1146941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical