Healthcare Provider Details

I. General information

NPI: 1780742080
Provider Name (Legal Business Name): MARILYN F. ABRAHAMSON MA,CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 WEST MAIN STREET CENTRASTATE MEDICAL CENTER
FREEHOLD NJ
07728
US

IV. Provider business mailing address

901 WEST MAIN STREET
FREEHOLD NJ
07728
US

V. Phone/Fax

Practice location:
  • Phone: 732-637-6303
  • Fax: 732-294-2568
Mailing address:
  • Phone: 732-637-6303
  • Fax: 732-294-2568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YS00235300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: