MEDICARE: DR. FRED JOSEPH RAHAIM PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY0002524	FL

General Provider Information

NPI Number	:	1265475412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRED JOSEPH RAHAIM PH.D.

Provider Business Mailing Address
First Line	:	5635 CREST CREEK DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-5358
Country	:	US
Telephone Number	:	904-880-7095
Fax Number	:	904-880-0652

Provider Business Practice Location Address
First Line	:	5635 CREST CREEK DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-5358
Country	:	US
Telephone Number	:	904-880-7095
Fax Number	:	904-880-0652

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	07/08/2007

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