Healthcare Provider Details

I. General information

NPI: 1649623000
Provider Name (Legal Business Name): KIM ABRAM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 MILL ST
MIDDLETOWN CT
06457-4468
US

IV. Provider business mailing address

253 SPENCER DR
MIDDLETOWN CT
06457-3584
US

V. Phone/Fax

Practice location:
  • Phone: 860-966-1292
  • Fax:
Mailing address:
  • Phone: 860-966-1292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number007869
License Number StateCT

VIII. Authorized Official

Name: KIM LYNN ABRAM
Title or Position: THERAPIST
Credential: LCSW
Phone: 860-966-1292