Provider Demographics
NPI:1619569423
Name:KADUTHANATHU ABRAHAM, ROSHIN (LPCC, LAADC)
Entity Type:Individual
Prefix:MRS
First Name:ROSHIN
Middle Name:
Last Name:KADUTHANATHU ABRAHAM
Suffix:
Gender:F
Credentials:LPCC, LAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 TERALBA CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95139
Mailing Address - Country:US
Mailing Address - Phone:714-757-1177
Mailing Address - Fax:
Practice Address - Street 1:158 TERALBA CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95139
Practice Address - Country:US
Practice Address - Phone:714-757-1177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALR0150315101YA0400X
CALPCC7974106H00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist