Healthcare Provider Details

I. General information

NPI: 1427980390
Provider Name (Legal Business Name): GABRIEL GHANOUM PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 JEFFERY ST APT 610
BOCA RATON FL
33487-4137
US

IV. Provider business mailing address

859 JEFFERY ST APT 610
BOCA RATON FL
33487-4137
US

V. Phone/Fax

Practice location:
  • Phone: 305-775-1031
  • Fax: 305-675-2899
Mailing address:
  • Phone: 305-794-5716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberNA
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: