Provider Demographics
NPI:1558650564
Name:ABRAHAM, JENNIFER ALPHONSO (PHD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ALPHONSO
Last Name:ABRAHAM
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Gender:F
Credentials:PHD
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Mailing Address - Street 1:2931 E BIDDLE ST
Mailing Address - Street 2:PATIENT ACCOUNTING
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-3939
Mailing Address - Country:US
Mailing Address - Phone:443-923-1870
Mailing Address - Fax:443-923-1895
Practice Address - Street 1:707 N BROADWAY
Practice Address - Street 2:KENNEDY KRIEGER INSTITUTE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-1832
Practice Address - Country:US
Practice Address - Phone:443-923-9400
Practice Address - Fax:443-923-9405
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MD04769103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist