Provider Demographics
NPI:1215338900
Name:KASSABRI, RATIBA (MED, EDS)
Entity type:Individual
Prefix:
First Name:RATIBA
Middle Name:
Last Name:KASSABRI
Suffix:
Gender:F
Credentials:MED, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 30TH ST APT 8
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-2447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6091 AYERS RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OH
Practice Address - Zip Code:45710-9492
Practice Address - Country:US
Practice Address - Phone:740-698-8831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool