Provider Demographics
NPI:1306118450
Name:ABRAHAM, KIDANE
Entity type:Individual
Prefix:
First Name:KIDANE
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 S. FREDERICK STREET
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-4304
Mailing Address - Country:US
Mailing Address - Phone:410-327-6503
Mailing Address - Fax:410-327-6825
Practice Address - Street 1:3 S. FREDERICK STREET
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-4304
Practice Address - Country:US
Practice Address - Phone:410-327-6503
Practice Address - Fax:410-327-6825
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD112091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical