Provider Demographics
NPI:1861852113
Name:FASSIH, ALI (BCBA)
Entity Type:Individual
Prefix:MR
First Name:ALI
Middle Name:
Last Name:FASSIH
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5911 JULIAN LN
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1148
Mailing Address - Country:US
Mailing Address - Phone:818-857-7576
Mailing Address - Fax:
Practice Address - Street 1:4501 CEDROS AVE
Practice Address - Street 2:#124
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2801
Practice Address - Country:US
Practice Address - Phone:818-857-7576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-29
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-15-19244103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst