Provider Demographics
NPI:1679691125
Name:ABRAHAM, DEEPA (PHD)
Entity type:Individual
Prefix:
First Name:DEEPA
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7080 DONLON WAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568
Mailing Address - Country:US
Mailing Address - Phone:925-803-1133
Mailing Address - Fax:
Practice Address - Street 1:7080 DONLON WAY
Practice Address - Street 2:SUITE 104
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568
Practice Address - Country:US
Practice Address - Phone:925-803-1133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18092103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY18092OtherBOARD OF PSYCHOLOGY
OPL180920Medicare ID - Type Unspecified
P60591Medicare UPIN