Provider Demographics
NPI:1407005341
Name:ABRAM, KIM L (LCSW)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:L
Last Name:ABRAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:L
Other - Last Name:BOUTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:53 MULBERRY LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-1784
Mailing Address - Country:US
Mailing Address - Phone:860-966-1292
Mailing Address - Fax:
Practice Address - Street 1:80 SHUNPIKE RD
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-4401
Practice Address - Country:US
Practice Address - Phone:860-788-5462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2020-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker