Provider Information for 1063925501
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ALWIN SUNNY ABRAHAM
Other Names:Professional Name:ALWIN S ABRAHAM LCSWSex: Male
NPI: 1063925501
Last Updated: 2019-05-16
Certification Date:
Certification Date:
Details
Name | Value | ||||||||||||
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NPI | 1063925501 | ||||||||||||
Enumeration Date | 2017-11-07 | ||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||
Sole Proprietor | YES | ||||||||||||
Status | Active | ||||||||||||
Mailing Address | 8235 MOURNING DOVE CT WOODRIDGE, IL 60517-4508 United States Phone: 610-914-0409 | Fax: | ||||||||||||
Primary Practice Address | 8235 MOURNING DOVE CT WOODRIDGE, IL 60517-6051 United States Phone: 630-914-0409 | Fax: | ||||||||||||
Secondary Practice Address(es) | 1900 E MAIN ST | ||||||||||||
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