MEDICARE: ASSESSMENT AND DEVELOPMENT CENTER OF SACRAMENTO

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

General Provider Information

NPI Number	:	1750916177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSESSMENT AND DEVELOPMENT CENTER OF SACRAMENTO

Provider Business Mailing Address
First Line	:	1555 RIVER PARK DR STE 103
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95815-4603
Country	:	US
Telephone Number	:	916-692-8837
Fax Number	:	916-200-3196

Provider Business Practice Location Address
First Line	:	1555 RIVER PARK DR STE 103
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95815-4603
Country	:	US
Telephone Number	:	916-692-8837
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL PSYCHOLOGIST
Name	:	SHIBA RAHIMI
Credential	:	PSY.D.
Telephone Number	:	916-969-7588

Provider Enumeration Date	:	03/05/2020
Last Update Date	:	12/19/2025

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