Provider Demographics
NPI:1285006155
Name:MALACHITE INSTITUTE FOR BEHAVIORAL HEALTH CORPORATION
Entity Type:Organization
Organization Name:MALACHITE INSTITUTE FOR BEHAVIORAL HEALTH CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSEM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:202-248-0316
Mailing Address - Street 1:5415 CONNECTICUT AVE NW
Mailing Address - Street 2:SUITE T43
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2765
Mailing Address - Country:US
Mailing Address - Phone:202-248-0316
Mailing Address - Fax:
Practice Address - Street 1:5415 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE T43
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2765
Practice Address - Country:US
Practice Address - Phone:202-248-0316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000650103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty