MEDICARE: DR. ROBIN R. ABRAHAM PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	LP4767	MN
2	103TC1900X	Counseling Psychologist	2626-057	WI

General Provider Information

NPI Number	:	1063637627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBIN R. ABRAHAM PSY.D.

Provider Business Mailing Address
First Line	:	2002 WILSON ST
Second Line	:	#3
City	:	MENOMONIE
State	:	WI
Zip	:	54751-1470
Country	:	US
Telephone Number	:	715-232-0888
Fax Number	:

Provider Business Practice Location Address
First Line	:	7040 LAKELAND AVE N
Second Line	:	SUITE #208
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55428-5600
Country	:	US
Telephone Number	:	763-560-8331
Fax Number	:	763-560-8431

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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