Provider Demographics
NPI:1194919845
Name:ABRAMS, ELAINE GERRY (MFT)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:GERRY
Last Name:ABRAMS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5540 MULBERRY DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-3833
Mailing Address - Country:US
Mailing Address - Phone:707-538-7203
Mailing Address - Fax:707-538-0706
Practice Address - Street 1:403 CHINN ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4338
Practice Address - Country:US
Practice Address - Phone:707-578-6444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMEC28231174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist