=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053647974
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELLEN RACHEL ABRAMS LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2009
-----------------------------------------------------
Last Update Date | 10/28/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 SOUTH SENECA ST SUITE 200
-----------------------------------------------------
City | ITHACA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-387-8205
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 42 CAYUGA ST
-----------------------------------------------------
City | TRUMANSBURG
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14886-9106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-387-8205
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 000602-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------