MEDICARE: LAYLA KASSEM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	071-005544	IL

General Provider Information

NPI Number	:	1861625246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAYLA KASSEM

Provider Business Mailing Address
First Line	:	4801 CONNECTICUT AVE NW
Second Line	:	APT 912
City	:	WASHINGTON
State	:	DC
Zip	:	20008-2207
Country	:	US
Telephone Number	:	773-865-9286
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 CONNECTICUT AVE NW
Second Line	:	APT 912
City	:	WASHINGTON
State	:	DC
Zip	:	20008-2207
Country	:	US
Telephone Number	:	773-865-9286
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2009
Last Update Date	:	09/01/2009

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Directions to “ LAYLA KASSEM ” Practice Location

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