Provider Demographics
NPI:1457356750
Name:GHARAIBEH, PAMELA (MSW, LMSW, ACSW)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:GHARAIBEH
Suffix:
Gender:F
Credentials:MSW, LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42243 ANN ARBOR RD E
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4364
Mailing Address - Country:US
Mailing Address - Phone:734-612-0985
Mailing Address - Fax:509-479-2867
Practice Address - Street 1:42243 ANN ARBOR RD E
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4364
Practice Address - Country:US
Practice Address - Phone:734-612-0985
Practice Address - Fax:509-479-2867
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010718801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI352739000OtherMAGELLAN MIS #
MI8008902970OtherBCBS PIN #
MI8008902970OtherBCBS PIN #