Provider Demographics
NPI:1417179839
Name:CRAIG E. ABRAHAMSON & ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:CRAIG E. ABRAHAMSON & ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:EILERT
Authorized Official - Last Name:ABRAHAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C, PHD
Authorized Official - Phone:301-334-9202
Mailing Address - Street 1:POST OFFICE BOX 74
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-0074
Mailing Address - Country:US
Mailing Address - Phone:301-334-9202
Mailing Address - Fax:
Practice Address - Street 1:619 NEST LICK ACRES ROAD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-4134
Practice Address - Country:US
Practice Address - Phone:301-334-9202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCSW-C 60121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD189519200Medicaid
MD794201000Medicaid
MDJQQ17CE27Medicare ID - Type UnspecifiedMEDICARE PROVIDER #