MEDICARE: MR. MUHAMMAD RIDWAN RAHMAN LCSW

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	101YM0800X	Mental Health Counselor	LCS 23383	CA

General Provider Information

NPI Number	:	1003947714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MUHAMMAD RIDWAN RAHMAN LCSW

Provider Business Mailing Address
First Line	:	21411 PLANE TREE LN
Second Line	:	# 202
City	:	NEWHALL
State	:	CA
Zip	:	91321-4475
Country	:	US
Telephone Number	:	661-618-2213
Fax Number	:

Provider Business Practice Location Address
First Line	:	27141 HIDAWAY AVE
Second Line	:	# 205
City	:	SANTA CLARITA
State	:	CA
Zip	:	91351-4131
Country	:	US
Telephone Number	:	661-618-2213
Fax Number	:

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	07/08/2007

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