Provider Demographics
NPI:1649623000
Name:KIM ABRAM LLC
Entity type:Organization
Organization Name:KIM ABRAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ABRAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-966-1292
Mailing Address - Street 1:253 SPENCER DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3584
Mailing Address - Country:US
Mailing Address - Phone:860-966-1292
Mailing Address - Fax:
Practice Address - Street 1:79 MILL ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4468
Practice Address - Country:US
Practice Address - Phone:860-966-1292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007869251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health