Healthcare Provider Details

I. General information

NPI: 1497355721
Provider Name (Legal Business Name): ABIGAIL TRUAX MA, LCAT, RDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 W 100TH ST
NEW YORK NY
10025-5104
US

IV. Provider business mailing address

164 W 100TH ST
NEW YORK NY
10025-5104
US

V. Phone/Fax

Practice location:
  • Phone: 475-329-9038
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number002696
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: