Provider Demographics
NPI:1518404086
Name:PENNY MICHELE ABRAMS PHD
Entity Type:Organization
Organization Name:PENNY MICHELE ABRAMS PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:617-651-7582
Mailing Address - Street 1:9404 GENESEE AVE
Mailing Address - Street 2:SUITE 245
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1339
Mailing Address - Country:US
Mailing Address - Phone:713-906-9057
Mailing Address - Fax:
Practice Address - Street 1:9404 GENESEE AVE
Practice Address - Street 2:SUITE 245
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1339
Practice Address - Country:US
Practice Address - Phone:713-906-9057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20753103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty