Provider Demographics
NPI:1083355283
Name:RAHMAN, MARIAM KHALIL (PHD)
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:KHALIL
Last Name:RAHMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2536 90TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11369-1708
Mailing Address - Country:US
Mailing Address - Phone:718-427-0703
Mailing Address - Fax:
Practice Address - Street 1:1425 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6514
Practice Address - Country:US
Practice Address - Phone:212-659-8752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist