Provider Demographics
NPI:1023478682
Name:ABRAHAM, GINA HELEN (MSED, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:HELEN
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:MSED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 VESTAL PKWY E
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-1629
Mailing Address - Country:US
Mailing Address - Phone:646-320-0790
Mailing Address - Fax:
Practice Address - Street 1:225 VESTAL PKWY E
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-1629
Practice Address - Country:US
Practice Address - Phone:646-320-0790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY897875141174400000X
NY897877141174400000X
NY103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist