| Doctor Name: | DR. JESS H GHANNAM |
| NPI Number: | 1285790154 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | PSY9261 |
| Business Practice Address: | 1335 Stanford Emeryville, CA - 946082536 |
| Business Phone Number: | 5106475101 |
| Business Fax Number: | 5106475105 |
| Mailing Address: | 1939 Divisadero St, # 3 SAN FRANCISCO |
| State: | CA |
| Postal Code: | 941152507 |
| Phone Number: | 4159218096 |
| Fax Number: | 4153543377 |
| NPI Enumeration Date: | 12/28/2006 |
| NPI Last Update Date: | 09/05/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103G00000X |
| License Number: | PSY9261 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Clinical Neuropsychologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |