Provider Demographics
NPI:1609377316
Name:FARAJ, YASSAMIN (MED, BCBA)
Entity Type:Individual
Prefix:MS
First Name:YASSAMIN
Middle Name:
Last Name:FARAJ
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5669 SNELL AVE # 130
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3328
Mailing Address - Country:US
Mailing Address - Phone:408-300-1242
Mailing Address - Fax:800-707-5502
Practice Address - Street 1:3851 CHARTER PARK DR STE V
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95136-1385
Practice Address - Country:US
Practice Address - Phone:408-300-1242
Practice Address - Fax:800-707-5502
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-15-20924103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty