Provider Demographics
NPI:1780210872
Name:ABRAHAM, SEAN ALEXANDER
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:ALEXANDER
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 S WALNUT SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-7422
Mailing Address - Country:US
Mailing Address - Phone:317-540-4358
Mailing Address - Fax:
Practice Address - Street 1:5534 SAINT JOE RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46835-3328
Practice Address - Country:US
Practice Address - Phone:812-200-0513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99095041A104100000X
IN34009731A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker