Healthcare Provider Details

I. General information

NPI: 1689191066
Provider Name (Legal Business Name): JASMINE MOSAFER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date: 02/09/2019
Reactivation Date: 08/25/2021

III. Provider practice location address

323 N PRAIRIE AVE
INGLEWOOD CA
90301-4502
US

IV. Provider business mailing address

4760 SEPULVEDA BLVD
CULVER CITY CA
90230-4820
US

V. Phone/Fax

Practice location:
  • Phone: 310-677-7808
  • Fax:
Mailing address:
  • Phone: 310-390-6612
  • Fax: 310-398-5690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number125266
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number125266
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number125266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: