Provider Demographics
NPI:1881075547
Name:ABRAHAM, ADAM
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3280 NOSTRAND AVE
Mailing Address - Street 2:110
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3755
Mailing Address - Country:US
Mailing Address - Phone:646-247-1744
Mailing Address - Fax:
Practice Address - Street 1:3280 NOSTRAND AVE
Practice Address - Street 2:110
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3755
Practice Address - Country:US
Practice Address - Phone:646-247-1744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006553101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health