Provider Demographics
NPI:1952490138
Name:ABRAMS, JUDITH (LCSW)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:ABRAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1346 VICTORY BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:STATE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301
Mailing Address - Country:US
Mailing Address - Phone:917-273-2300
Mailing Address - Fax:
Practice Address - Street 1:CLOVE LAKES CENTER FOR PSYCH
Practice Address - Street 2:1346 VICTORY BOULEVARD
Practice Address - City:STATE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301
Practice Address - Country:US
Practice Address - Phone:917-273-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR02751211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY144871OtherVALUE OPTIONS
NY01779900Medicaid
NY7400243OtherGHI
NYN42781Medicare ID - Type Unspecified