Provider Demographics
NPI:1619009958
Name:DENGELEGI ABRAMS, LIDIA D (PHD)
Entity Type:Individual
Prefix:
First Name:LIDIA
Middle Name:D
Last Name:DENGELEGI ABRAMS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LIDIA
Other - Middle Name:
Other - Last Name:DENGELEGI ABRAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:120 MOUNTAIN PARK RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-1152
Mailing Address - Country:US
Mailing Address - Phone:973-742-3113
Mailing Address - Fax:973-742-8511
Practice Address - Street 1:120 MOUNTAIN PARK RD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1152
Practice Address - Country:US
Practice Address - Phone:973-742-3113
Practice Address - Fax:973-742-8511
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100296800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDE732475Medicare ID - Type Unspecified