Provider Demographics
NPI:1932246238
Name:ABRAHAM, BEVERLY ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:ANN
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 GRANDVIEW AVENUE
Mailing Address - Street 2:
Mailing Address - City:CORNWALL ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12520-1217
Mailing Address - Country:US
Mailing Address - Phone:845-534-4385
Mailing Address - Fax:
Practice Address - Street 1:39 GRANDVIEW AVENUE
Practice Address - Street 2:
Practice Address - City:CORNWALL ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12520-1217
Practice Address - Country:US
Practice Address - Phone:845-534-4385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013183103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01898448Medicaid
NY01898448Medicaid