Provider Demographics
NPI:1053757468
Name:ABRAHAM, MAKEDA (LMFT)
Entity type:Individual
Prefix:MS
First Name:MAKEDA
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 KESTER AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2006
Mailing Address - Country:US
Mailing Address - Phone:818-259-8172
Mailing Address - Fax:
Practice Address - Street 1:16530 VENTURA BLVD STE 400
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4551
Practice Address - Country:US
Practice Address - Phone:424-259-2703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 74558101YM0800X
CA99273106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAIMF 74558OtherMFT INTERN REGISTRATION NUMBER