Provider Demographics
NPI:1609461508
Name:ELAZARI, JASMINE MIRIAM (MA)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:MIRIAM
Last Name:ELAZARI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4521 SHERMAN OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3807
Mailing Address - Country:US
Mailing Address - Phone:310-666-6276
Mailing Address - Fax:
Practice Address - Street 1:445 CASTLE PL
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-1858
Practice Address - Country:US
Practice Address - Phone:310-666-6276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106028106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist