Basic Information
| Provider Information | |||||||||
| NPI: | 1407864887 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABRAMOVICH | ||||||||
| FirstName: | IRENE | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1216 FARMINGTON AVE | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | WEST HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061072672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605615515 | ||||||||
| FaxNumber: | 8602170631 | ||||||||
| Practice Location | |||||||||
| Address1: | 1216 FARMINGTON AVE | ||||||||
| Address2: | 304 | ||||||||
| City: | WEST HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060402672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605615515 | ||||||||
| FaxNumber: | 8606454132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 06/06/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 033192 | CT | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 001331925 | 05 | CT | MEDICAID |