Provider Demographics
NPI:1265544019
Name:ABRAHAM, JOSEPH MICHAEL (LCSW ACSW CADC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:LCSW ACSW CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 W LINCOLN AVE
Mailing Address - Street 2:308
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2136
Mailing Address - Country:US
Mailing Address - Phone:414-329-7000
Mailing Address - Fax:414-329-7010
Practice Address - Street 1:10201 W LINCOLN AVE
Practice Address - Street 2:308
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2136
Practice Address - Country:US
Practice Address - Phone:414-329-7000
Practice Address - Fax:414-329-7010
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1740123104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI12074OtherCADC
WI1740123OtherLCSW
WI39545600Medicaid
WI39545600Medicaid