Provider Demographics
NPI:1144367723
Name:KHAMIS, JASMINE MAHMOUD (EDM)
Entity type:Individual
Prefix:MS
First Name:JASMINE
Middle Name:MAHMOUD
Last Name:KHAMIS
Suffix:
Gender:F
Credentials:EDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-5003
Mailing Address - Country:US
Mailing Address - Phone:518-331-3110
Mailing Address - Fax:
Practice Address - Street 1:23 PEARL ST
Practice Address - Street 2:APT #2
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-5003
Practice Address - Country:US
Practice Address - Phone:518-331-3110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool