Provider Demographics
NPI:1689123820
Name:TAKESIAN, ABIGAIL (LICSW)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:TAKESIAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44R BRATTLE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-3705
Mailing Address - Country:US
Mailing Address - Phone:617-299-9904
Mailing Address - Fax:
Practice Address - Street 1:44R BRATTLE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-3705
Practice Address - Country:US
Practice Address - Phone:617-299-9904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC177351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1417209826Medicaid
ME1366786410Medicaid