Provider Demographics
NPI:1104377183
Name:ABRAMS, KENNETH EARL JR (MSW)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:EARL
Last Name:ABRAMS
Suffix:JR
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4795 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46409-2403
Mailing Address - Country:US
Mailing Address - Phone:219-887-3688
Mailing Address - Fax:219-887-2666
Practice Address - Street 1:4795 BROADWAY
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46409-2403
Practice Address - Country:US
Practice Address - Phone:219-887-3688
Practice Address - Fax:219-887-2666
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical