Provider Demographics
NPI:1790067395
Name:RAHMAN, TAMANNA (APRN, CPRP)
Entity Type:Individual
Prefix:
First Name:TAMANNA
Middle Name:
Last Name:RAHMAN
Suffix:
Gender:F
Credentials:APRN, CPRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E MAIN ST
Mailing Address - Street 2:4TH FLOOR ADMINISTRATION
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-2310
Mailing Address - Country:US
Mailing Address - Phone:203-574-9000
Mailing Address - Fax:203-574-9006
Practice Address - Street 1:270 CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519
Practice Address - Country:US
Practice Address - Phone:203-764-9995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT122042163W00000X
CT6582363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT13872963OtherCAQH
CTCSP.0063703OtherCONTROLLED SUBSTANCE REGISTRATION FOR PRACTICIONER
CTPENDINGOtherMANAGED HEALTH NETWORK/MHN
CTPENDINGOtherCIGNA BEHAVIORAL HEALTH
CT060669107OtherOPTUM BEHAVIORAL HEALTH/UBH WELLMORE GRP/FACILITY
CT060669107OtherCONNECTICARE/UBH WELLMORE GRP/FACILITY
CTPENDINGOtherAETNA BEHAVIORAL HEALTH
CTPENDINGOtherMHN/TRICARENORTH
CTPMHNP-BC 2016011186OtherCOMMISSION ON CERTIFICATION ANCC-PSYCHIATRIC MENTAL HEALTH NURSE PRACCTIITIONER
CT060669107OtherHEALTHYCT WELLMORE GRP/FACILITY
CT060669107OtherUNITED HEALTHCARE/UBH WELLMORE GRP/FACILITY
CT4887750OtherCERTIFIED PSYCHIATRIC REHABILITIATION PRACTITIONER
CTPENDINGMedicaid
CT060669107OtherANTHEM BEHAVIORAL HEALTH GRP/FACILITY
CT060669107OtherLIBERTY/OXFORD FREEDOM PLANS/UBH WELLMORE GRP/FACILITY
CTD339123 WATERBURYOtherBEACON HEALTH STRATEGIES
CTMR3961592OtherDEA DRUG ENFORCEMENT ADMINISTRATION
CT060669107OtherANTHEM BEHAVIORAL HEALTH GRP/FACILITY