Provider Demographics
NPI:1710456470
Name:HANNAWI, SAMAR FOUAD (MA TLLP)
Entity Type:Individual
Prefix:
First Name:SAMAR
Middle Name:FOUAD
Last Name:HANNAWI
Suffix:
Gender:F
Credentials:MA TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 PELHAM STREET
Mailing Address - Street 2:SUITE #13
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124
Mailing Address - Country:US
Mailing Address - Phone:313-429-0470
Mailing Address - Fax:
Practice Address - Street 1:3815 PELHAM STREET
Practice Address - Street 2:SUITE #13
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:313-429-0470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-24
Last Update Date:2018-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist