Provider Demographics
NPI:1124229505
Name:RAHMAN, KATHLEEN KEOGH (PHD LCSW ACSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:KEOGH
Last Name:RAHMAN
Suffix:
Gender:F
Credentials:PHD LCSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 FIVE POINT ROAD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2628
Mailing Address - Country:US
Mailing Address - Phone:757-496-6090
Mailing Address - Fax:
Practice Address - Street 1:829 FIVE POINT ROAD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2628
Practice Address - Country:US
Practice Address - Phone:757-496-6090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040030971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical