Provider Demographics
NPI:1861625246
Name:KASSEM, LAYLA
Entity type:Individual
Prefix:
First Name:LAYLA
Middle Name:
Last Name:KASSEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 CONNECTICUT AVE NW
Mailing Address - Street 2:APT 912
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-2207
Mailing Address - Country:US
Mailing Address - Phone:773-865-9286
Mailing Address - Fax:
Practice Address - Street 1:4801 CONNECTICUT AVE NW
Practice Address - Street 2:APT 912
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2207
Practice Address - Country:US
Practice Address - Phone:773-865-9286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005544103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical