Provider Demographics
NPI:1437963667
Name:GHANIM, MANAL
Entity type:Individual
Prefix:
First Name:MANAL
Middle Name:
Last Name:GHANIM
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 1:1887 RICHMOND AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3923
Mailing Address - Country:US
Mailing Address - Phone:718-698-1300
Mailing Address - Fax:917-677-6801
Practice Address - Street 1:1887 RICHMOND AVE STE 5
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3923
Practice Address - Country:US
Practice Address - Phone:718-698-1300
Practice Address - Fax:917-677-6801
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health