Healthcare Provider Details

I. General information

NPI: 1457625527
Provider Name (Legal Business Name): BINU ABRAHAM MSW, LICSW, LCSW-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8221 WILLOW OAKS CORPORATE DR
FAIRFAX VA
22031-4512
US

IV. Provider business mailing address

13201 TANEY DR
BELTSVILLE MD
20705-3254
US

V. Phone/Fax

Practice location:
  • Phone: 703-289-7560
  • Fax:
Mailing address:
  • Phone: 301-503-6623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50079223
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13813
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number13813
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904008842
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: