MEDICARE: STARLA ABRAHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	65790	TX

General Provider Information

NPI Number	:	1356056527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STARLA ABRAHAM

Provider Business Mailing Address
First Line	:	391 LAS COLINAS BLVD E # 130-342
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-6291
Country	:	US
Telephone Number	:	469-315-8527
Fax Number	:

Provider Business Practice Location Address
First Line	:	4347 S HAMPTON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75232-1065
Country	:	US
Telephone Number	:	469-315-8527
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2023
Last Update Date	:	01/20/2023

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Directions to “ STARLA ABRAHAM ” Practice Location

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