Provider Demographics
NPI:1053729632
Name:ABRAHAM, STACEY (LICSW)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:ABRAHAM
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 1:2208 MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-1304
Mailing Address - Country:US
Mailing Address - Phone:301-262-2270
Mailing Address - Fax:410-569-0094
Practice Address - Street 1:65 MASSACHUSETTS AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-1431
Practice Address - Country:US
Practice Address - Phone:301-262-2270
Practice Address - Fax:410-569-0094
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500794881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical