Provider Demographics
NPI:1770654022
Name:ABRAHAMS, GEORGE (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:ABRAHAMS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1678 SELBY AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6149
Mailing Address - Country:US
Mailing Address - Phone:651-647-5722
Mailing Address - Fax:651-647-5723
Practice Address - Street 1:1678 SELBY AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6149
Practice Address - Country:US
Practice Address - Phone:651-647-5722
Practice Address - Fax:651-647-5723
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0704103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN59315ABOtherBLUE CROSSBLUE SHIELD