Provider Demographics
NPI:1730512997
Name:MOBED, SIROUSS (PSYD,LMHC,MS,MED)
Entity type:Individual
Prefix:DR
First Name:SIROUSS
Middle Name:
Last Name:MOBED
Suffix:
Gender:M
Credentials:PSYD,LMHC,MS,MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11108 MANDARIN DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-8026
Mailing Address - Country:US
Mailing Address - Phone:352-242-3746
Mailing Address - Fax:
Practice Address - Street 1:11108 MANDARIN DR
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-8026
Practice Address - Country:US
Practice Address - Phone:352-242-3746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0003499101YM0800X
251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251B00000XAgenciesCase Management