Provider Demographics
NPI:1598961112
Name:ABRAHAM, JANE (PHD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 ANGELUS ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-5202
Mailing Address - Country:US
Mailing Address - Phone:901-272-1657
Mailing Address - Fax:901-726-4281
Practice Address - Street 1:1384 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2327
Practice Address - Country:US
Practice Address - Phone:901-828-1332
Practice Address - Fax:901-726-4281
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW40951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical