Provider Demographics
NPI:1780742080
Name:ABRAHAMSON, MARILYN F (MA,CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:F
Last Name:ABRAHAMSON
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728
Mailing Address - Country:US
Mailing Address - Phone:732-637-6303
Mailing Address - Fax:732-294-2568
Practice Address - Street 1:901 WEST MAIN STREET
Practice Address - Street 2:CENTRASTATE MEDICAL CENTER
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728
Practice Address - Country:US
Practice Address - Phone:732-637-6303
Practice Address - Fax:732-294-2568
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00235300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist