Provider Demographics
NPI:1063925501
Name:ABRAHAM, ALWIN SUNNY
Entity type:Individual
Prefix:
First Name:ALWIN
Middle Name:SUNNY
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ALWIN
Other - Middle Name:S
Other - Last Name:ABRAHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:8235 MOURNING DOVE CT
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-4508
Mailing Address - Country:US
Mailing Address - Phone:610-914-0409
Mailing Address - Fax:
Practice Address - Street 1:8235 MOURNING DOVE CT
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-6051
Practice Address - Country:US
Practice Address - Phone:630-914-0409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.101618104100000X
IL149.0202261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker