MEDICARE: ELISSA BETH ABRAMS MA, LP

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	103T00000X	Psychologist	0770	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10D28AB	OTHER	MN	BCBS

General Provider Information

NPI Number	:	1982766598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISSA BETH ABRAMS MA, LP

Provider Business Mailing Address
First Line	:	8703 SHEPHERD WAY
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55347-5317
Country	:	US
Telephone Number	:	612-990-7171
Fax Number	:

Provider Business Practice Location Address
First Line	:	3570 LEXINGTON AVE N
Second Line	:	SUITE 100
City	:	SHOREVIEW
State	:	MN
Zip	:	55126-8049
Country	:	US
Telephone Number	:	651-481-0664
Fax Number	:

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	07/08/2007

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