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NPI Code Detail

MEDICARE: GINA IBRAHIM

MEDICARE: GINA IBRAHIM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior AnalystMI
2106S00000XBehavior Technician
3247200000XOther Technician
4103K00000XBehavior Analyst1-24-72752MI

General Provider Information

NPI Number : 1326663832
Entity Type Code : Individual
Provider Name (Legal Business Name) : GINA IBRAHIM
Provider Business Mailing Address
First Line : 42284 DHARTE CT
Second Line :
City : CLINTON TOWNSHIP
State : MI
Zip : 48038-6433
Country : US
Telephone Number : 586-265-8230
Fax Number :
Provider Business Practice Location Address
First Line : 3002 CARPENTER ST
Second Line :
City : HAMTRAMCK
State : MI
Zip : 48212-2768
Country : US
Telephone Number : 313-288-9793
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2020
Last Update Date : 06/24/2025

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Directions to “ GINA IBRAHIM ” Practice Location

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