Provider Demographics
NPI:1811407398
Name:TRISHA ABBEY
Entity Type:Organization
Organization Name:TRISHA ABBEY
Other - Org Name:TRISHA ABBEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBEY
Authorized Official - Suffix:I
Authorized Official - Credentials:DO
Authorized Official - Phone:443-987-5907
Mailing Address - Street 1:1326 TRALEE CIRCLE
Mailing Address - Street 2:NONE
Mailing Address - City:ABERDEEN
Mailing Address - State:MARYLAND
Mailing Address - Zip Code:21001
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1326 TRALEE CIRCLE
Practice Address - Street 2:NONE
Practice Address - City:ABERDEEN
Practice Address - State:MARYLAND
Practice Address - Zip Code:21001
Practice Address - Country:UM
Practice Address - Phone:443-987-5907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDY-4361157936401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL20110118000713Medicaid