Healthcare Provider Details

I. General information

NPI: 1912327545
Provider Name (Legal Business Name): ABRAMS PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 TINTON AVE BUILDING. A, SUITE 203
TINTON FALLS NJ
07724-3260
US

IV. Provider business mailing address

620 TINTON AVE BUILDING. A, SUITE 203
TINTON FALLS NJ
07724-3260
US

V. Phone/Fax

Practice location:
  • Phone: 917-887-5206
  • Fax:
Mailing address:
  • Phone: 917-887-5206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3936
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number3936
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number3936
License Number StateNJ

VIII. Authorized Official

Name: DR. MITCH ABRAMS
Title or Position: PSYCHOLOGIST/PRINCIPAL
Credential: PSY.D.
Phone: 917-887-5206