Provider Demographics
NPI:1720959422
Name:MASOUD, ELSAYED
Entity type:Individual
Prefix:
First Name:ELSAYED
Middle Name:
Last Name:MASOUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4033 LAKE GLEN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-4380
Mailing Address - Country:US
Mailing Address - Phone:703-314-4241
Mailing Address - Fax:
Practice Address - Street 1:4033 LAKE GLEN RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-4380
Practice Address - Country:US
Practice Address - Phone:703-314-4241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty