Provider Demographics
NPI:1053959775
Name:ABRAHAM, MICHELLE AMY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:AMY
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:AMY
Other - Last Name:ABRAHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:325 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-5903
Mailing Address - Country:US
Mailing Address - Phone:212-604-6098
Mailing Address - Fax:212-367-0104
Practice Address - Street 1:325 W 15TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-5903
Practice Address - Country:US
Practice Address - Phone:212-604-6098
Practice Address - Fax:212-367-0104
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082436-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical