Provider Demographics
NPI:1992362735
Name:SAMJI, RAHIM (LCSW)
Entity Type:Individual
Prefix:
First Name:RAHIM
Middle Name:
Last Name:SAMJI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 FAIRFIELD AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-1543
Mailing Address - Country:US
Mailing Address - Phone:727-265-1598
Mailing Address - Fax:
Practice Address - Street 1:3010 FAIRFIELD AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-1543
Practice Address - Country:US
Practice Address - Phone:727-265-1598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW143861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical