1245332048 NPI number — MRS. HEIDI Z ABRAMS

Table of content: MRS. HEIDI Z ABRAMS (NPI 1245332048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245332048 NPI number — MRS. HEIDI Z ABRAMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABRAMS
Provider First Name:
HEIDI
Provider Middle Name:
Z
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZIMMERLI
Provider Other First Name:
HEIDI
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICSW CADAC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1245332048
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
385 RED TOP ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREWSTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02631-1643
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
774-212-0389
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23 25 BAY STATE COURT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BREWSTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02631-1643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
774-212-0389
Provider Business Practice Location Address Fax Number:
508-240-5448
Provider Enumeration Date:
09/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  107937 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YA0400X , with the licence number: 0905AD , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 219929 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 461430 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P07689 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 155144 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1852795 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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