Healthcare Provider Details

I. General information

NPI: 1689507006
Provider Name (Legal Business Name): SAMANTHA LUCINE KASSARJIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14724 VENTURA BLVD STE 1105
SHERMAN OAKS CA
91403-3510
US

IV. Provider business mailing address

4334 MATILIJA AVE APT 110
SHERMAN OAKS CA
91423-3601
US

V. Phone/Fax

Practice location:
  • Phone: 747-293-5495
  • Fax:
Mailing address:
  • Phone: 818-653-8309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: