Provider Demographics
NPI:1265221923
Name:KASSAM, JAVEED
Entity type:Individual
Prefix:
First Name:JAVEED
Middle Name:
Last Name:KASSAM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 OCEAN PARK BLVD UNIT 2219
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2905
Mailing Address - Country:US
Mailing Address - Phone:747-200-5373
Mailing Address - Fax:
Practice Address - Street 1:9713 SANTA MONICA BLVD STE 201
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4236
Practice Address - Country:US
Practice Address - Phone:310-564-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-01
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT153816106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist