Healthcare Provider Details

I. General information

NPI: 1033554084
Provider Name (Legal Business Name): MRS. JINY THOMAS ABRAHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2013
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13666 E 14TH ST
SAN LEANDRO CA
94578-2538
US

IV. Provider business mailing address

4717 N CEDAR AVE APT #102
FRESNO CA
93726-1005
US

V. Phone/Fax

Practice location:
  • Phone: 510-357-5515
  • Fax:
Mailing address:
  • Phone: 201-888-5413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: