Provider Demographics
NPI:1417109802
Name:GHONEIM, GLORIA D (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:D
Last Name:GHONEIM
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-1314
Mailing Address - Country:US
Mailing Address - Phone:732-531-9464
Mailing Address - Fax:
Practice Address - Street 1:145 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1717
Practice Address - Country:US
Practice Address - Phone:732-747-9660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC008528001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical