Healthcare Provider Details

I. General information

NPI: 1013445592
Provider Name (Legal Business Name): PUNAM RAHMAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SHERMAN AVE STE 210
EVANSTON IL
60201-5044
US

IV. Provider business mailing address

2020 PEACHTREE RD NW
ATLANTA GA
30309-1426
US

V. Phone/Fax

Practice location:
  • Phone: 855-264-9355
  • Fax:
Mailing address:
  • Phone: 315-404-1109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number071009529
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY004170
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071009529
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: