Healthcare Provider Details

I. General information

NPI: 1932246238
Provider Name (Legal Business Name): BEVERLY ANN ABRAHAM PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 GRANDVIEW AVENUE
CORNWALL ON HUDSON NY
12520-1217
US

IV. Provider business mailing address

39 GRANDVIEW AVENUE
CORNWALL ON HUDSON NY
12520-1217
US

V. Phone/Fax

Practice location:
  • Phone: 845-534-4385
  • Fax:
Mailing address:
  • Phone: 845-534-4385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number013183
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: