Provider Demographics
NPI:1033489570
Name:JARVI, KASSANDRA L
Entity Type:Individual
Prefix:MS
First Name:KASSANDRA
Middle Name:L
Last Name:JARVI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KASSANDRA
Other - Middle Name:L
Other - Last Name:CODY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7270 LASTING LIGHT WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5125
Mailing Address - Country:US
Mailing Address - Phone:443-745-1474
Mailing Address - Fax:
Practice Address - Street 1:7270 LASTING LIGHT WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5125
Practice Address - Country:US
Practice Address - Phone:443-745-1474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2079101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health