Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 071009529 | IL |
N | 103TC0700X | Clinical Psychologist | 071009529 | IL |
Y | 103G00000X | Clinical Psychologist | PSY004170 | GA |
Y | 103TC0700X | Clinical Psychologist | PSY004170 | GA |
N | 103TR0400X | Rehabilitation Psychologist | 071009529 | IL |
NPI | 1013445592 |
---|---|
Provider Name | Dr. Punam Rahman |
First Address | Atlanta, GA 30309-1426 |
Second Address | Evanston, IL 60201-5044 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2017 |
Last Update Date | 23/01/2018 |