Healthcare Provider Details

I. General information

NPI: 1457356750
Provider Name (Legal Business Name): PAMELA GHARAIBEH MSW, LMSW, ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42243 ANN ARBOR RD E
PLYMOUTH MI
48170-4364
US

IV. Provider business mailing address

42243 ANN ARBOR RD E
PLYMOUTH MI
48170-4364
US

V. Phone/Fax

Practice location:
  • Phone: 734-612-0985
  • Fax: 509-479-2867
Mailing address:
  • Phone: 734-612-0985
  • Fax: 509-479-2867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801071880
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: