Provider Demographics
NPI:1265475412
Name:RAHAIM, FRED JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:JOSEPH
Last Name:RAHAIM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5635 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:904-880-7095
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:904-880-7095
Practice Address - Fax:904-880-0652
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0002524103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical