Provider Demographics
NPI:1528418027
Name:ABRAHAMIAN, SANDRA (PMHNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:ABRAHAMIAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 SHREWSBURY ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-1691
Mailing Address - Country:US
Mailing Address - Phone:508-753-5554
Mailing Address - Fax:
Practice Address - Street 1:435 SHREWSBURY ST STE 1
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-1691
Practice Address - Country:US
Practice Address - Phone:508-753-5554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2299556363LP0808X, 163WC0400X, 163WC1500X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health