Provider Demographics
NPI:1497520076
Name:RAHIM, SAUDIA JAMEELA
Entity Type:Individual
Prefix:
First Name:SAUDIA
Middle Name:JAMEELA
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 1:14855 EDGEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-3210
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14855 EDGEWOOD ST
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-3210
Practice Address - Country:US
Practice Address - Phone:718-374-1273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-23
Last Update Date:2023-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP124983101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health