Provider Demographics
NPI:1881731966
Name:ABRAHAM, ZAIDA (LISW)
Entity type:Individual
Prefix:
First Name:ZAIDA
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 PINNACLE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-0938
Mailing Address - Country:US
Mailing Address - Phone:575-932-8053
Mailing Address - Fax:
Practice Address - Street 1:3831 E LOHMAN AVE STE 204
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8447
Practice Address - Country:US
Practice Address - Phone:575-932-8510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000514101YA0400X
NMI-064411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)