Provider Demographics
NPI:1477013803
Name:RAHIM, AMIRAH
Entity Type:Individual
Prefix:
First Name:AMIRAH
Middle Name:
Last Name:RAHIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 AUCKLAND DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-4299
Mailing Address - Country:US
Mailing Address - Phone:610-803-5509
Mailing Address - Fax:
Practice Address - Street 1:240 CHERRY ST
Practice Address - Street 2:
Practice Address - City:SHARON HILL
Practice Address - State:PA
Practice Address - Zip Code:19079-1308
Practice Address - Country:US
Practice Address - Phone:610-803-5509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2023-10-05
Deactivation Date:2019-03-22
Deactivation Code:
Reactivation Date:2019-04-17
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA83-1229169Medicaid