Provider Demographics
NPI:1447475579
Name:HARLEY, KASIMU-RICHARD (MFT)
Entity type:Individual
Prefix:MR
First Name:KASIMU-RICHARD
Middle Name:
Last Name:HARLEY
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2970 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-3296
Mailing Address - Country:US
Mailing Address - Phone:619-829-9140
Mailing Address - Fax:
Practice Address - Street 1:2970 MARKET ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-3296
Practice Address - Country:US
Practice Address - Phone:619-829-9140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 29988106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist