Provider Demographics
NPI:1598219420
Name:FASSETT, JASMINE MARIE (PSY S)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:MARIE
Last Name:FASSETT
Suffix:
Gender:F
Credentials:PSY S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 C ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-4100
Mailing Address - Country:US
Mailing Address - Phone:202-248-7773
Mailing Address - Fax:
Practice Address - Street 1:4300 C ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-4100
Practice Address - Country:US
Practice Address - Phone:202-248-7773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool