Provider Demographics
NPI:1275178436
Name:ABRAHAM, JENNIFER A (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:ZAROU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:135 ROCKY HILL RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-5524
Mailing Address - Country:US
Mailing Address - Phone:617-827-8060
Mailing Address - Fax:
Practice Address - Street 1:135 ROCKY HILL RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-5524
Practice Address - Country:US
Practice Address - Phone:617-827-8060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2190311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA842489462OtherLLC