Provider Demographics
NPI:1124469754
Name:ABRAMS, THEREASA (LCSW)
Entity type:Individual
Prefix:
First Name:THEREASA
Middle Name:
Last Name:ABRAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:THEREASA
Other - Middle Name:E
Other - Last Name:FERENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 19653
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9653
Mailing Address - Country:US
Mailing Address - Phone:217-545-8000
Mailing Address - Fax:217-545-2588
Practice Address - Street 1:747 N RUTLEDGE ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-6700
Practice Address - Country:US
Practice Address - Phone:217-545-8000
Practice Address - Fax:217-545-2588
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-007762104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL256514012Medicare PIN