MEDICARE: JENNIFER 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	136181	CA

General Provider Information

NPI Number	:	1578225942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ABRAHAM

Provider Business Mailing Address
First Line	:	7071 HAWTHORN AVE APT 10
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-6969
Country	:	US
Telephone Number	:	857-312-6277
Fax Number	:

Provider Business Practice Location Address
First Line	:	7071 HAWTHORN AVE APT 10
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-6969
Country	:	US
Telephone Number	:	857-312-6277
Fax Number	:

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

Provider Enumeration Date	:	10/12/2021
Last Update Date	:	05/26/2026

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