=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851024400
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIELA J ABREU
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2022
-----------------------------------------------------
Last Update Date | 12/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11 BROADWAY ST
-----------------------------------------------------
City | GLOVERSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12078-3968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-725-4310
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 303 W MONTGOMERY ST
-----------------------------------------------------
City | JOHNSTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12095-2402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-986-4012
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------