Provider Demographics
NPI:1598818304
Name:ABRAHAM, VIJAYA K (MA, MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:VIJAYA
Middle Name:K
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:MA, MSW, LCSW
Other - Prefix:MRS
Other - First Name:VIJAYA
Other - Middle Name:KUMARI
Other - Last Name:ABRAHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:67 MECHANIC ST.
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703
Mailing Address - Country:US
Mailing Address - Phone:150-822-3469
Mailing Address - Fax:
Practice Address - Street 1:67 MECHANIC ST.
Practice Address - Street 2:SOUTH BAY MENTAL HEALTH CENTER
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703
Practice Address - Country:US
Practice Address - Phone:150-822-3469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2137661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical