MEDICARE: AMIR ALI RAHMAN SR.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103T00000X	Psychologist
2	101YM0800X	Mental Health Counselor
3	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1770160467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMIR ALI RAHMAN SR.

Provider Business Mailing Address
First Line	:	3256 W 25TH ST APT 210
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-1562
Country	:	US
Telephone Number	:	216-785-0094
Fax Number	:

Provider Business Practice Location Address
First Line	:	3256 W 25TH ST APT 210
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-1562
Country	:	US
Telephone Number	:	216-785-0094
Fax Number	:

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

Provider Enumeration Date	:	03/27/2021
Last Update Date	:	03/27/2021

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