Provider Demographics
NPI:1710380019
Name:ABRAHAM, CHANANYA (LPC, MS)
Entity Type:Individual
Prefix:
First Name:CHANANYA
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:LPC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 HEWLETT ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06710-1615
Mailing Address - Country:US
Mailing Address - Phone:203-759-8007
Mailing Address - Fax:
Practice Address - Street 1:32 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06710-2217
Practice Address - Country:US
Practice Address - Phone:203-759-8007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health