Provider Demographics
NPI:1972939767
Name:FRED J. RAHAIM, PH.D. P.A.
Entity type:Organization
Organization Name:FRED J. RAHAIM, PH.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:RAHAIM
Authorized Official - Suffix:
Authorized Official - Credentials:PH,D
Authorized Official - Phone:904-704-0851
Mailing Address - Street 1:5635 CREST CREEK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5358
Mailing Address - Country:US
Mailing Address - Phone:904-704-0851
Mailing Address - Fax:904-880-0652
Practice Address - Street 1:5635 CREST CREEK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5358
Practice Address - Country:US
Practice Address - Phone:904-704-0851
Practice Address - Fax:904-880-0652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY00002524103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1265475412OtherNPI