Provider Demographics
NPI:1063637627
Name:ABRAHAM, ROBIN R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:R
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 WILSON ST
Mailing Address - Street 2:#3
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-1470
Mailing Address - Country:US
Mailing Address - Phone:715-232-0888
Mailing Address - Fax:
Practice Address - Street 1:7040 LAKELAND AVE N
Practice Address - Street 2:SUITE #208
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55428-5600
Practice Address - Country:US
Practice Address - Phone:763-560-8331
Practice Address - Fax:763-560-8431
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4767103TC1900X
WI2626-057103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling