Provider Demographics
NPI:1811224454
Name:ABRAHAM, KONDOOR VERGHESE (PSYD, LMHC)
Entity type:Individual
Prefix:DR
First Name:KONDOOR
Middle Name:VERGHESE
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:PSYD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 SW 116TH AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-4742
Mailing Address - Country:US
Mailing Address - Phone:954-916-1200
Mailing Address - Fax:
Practice Address - Street 1:1750 SW 116 AVE.,
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33325
Practice Address - Country:US
Practice Address - Phone:954-916-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH1215101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH1215OtherLICENSED MENTAL HEALTH COUNSELOR