Provider Demographics
NPI:1013445592
Name:RAHMAN, PUNAM (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PUNAM
Middle Name:
Last Name:RAHMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 PEACHTREE RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1426
Mailing Address - Country:US
Mailing Address - Phone:315-404-1109
Mailing Address - Fax:
Practice Address - Street 1:1601 SHERMAN AVE STE 210
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-5044
Practice Address - Country:US
Practice Address - Phone:855-264-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-30
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009529103TR0400X, 103TC0700X
GAPSY004170103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty