Provider Demographics
NPI:1215397500
Name:GHANEM, JOANNA D
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:D
Last Name:GHANEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1083 HERNANDEZ AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-5331
Mailing Address - Country:US
Mailing Address - Phone:702-540-7671
Mailing Address - Fax:702-552-7138
Practice Address - Street 1:1083 HERNANDEZ AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-5331
Practice Address - Country:US
Practice Address - Phone:702-540-7671
Practice Address - Fax:702-552-7138
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst