Provider Demographics
NPI:1578842076
Name:ABRAMS, MITCH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MITCH
Middle Name:
Last Name:ABRAMS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 KING GEORGE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:FORDS
Mailing Address - State:NJ
Mailing Address - Zip Code:08863-1974
Mailing Address - Country:US
Mailing Address - Phone:732-738-0900
Mailing Address - Fax:732-738-0815
Practice Address - Street 1:720 KING GEORGE RD STE 105
Practice Address - Street 2:
Practice Address - City:FORDS
Practice Address - State:NJ
Practice Address - Zip Code:08863-1974
Practice Address - Country:US
Practice Address - Phone:732-738-0900
Practice Address - Fax:732-738-0815
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3936103TC0700X
NY14186103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical