Provider Demographics
NPI:1245307180
Name:RAHAMIM, ELIZABETH BERGMAN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:BERGMAN
Last Name:RAHAMIM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4980 S ALMA SCHOOL RD STE A2-242
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-5605
Mailing Address - Country:US
Mailing Address - Phone:480-252-5152
Mailing Address - Fax:480-685-4948
Practice Address - Street 1:3377 S PRICE RD STE 103
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-3573
Practice Address - Country:US
Practice Address - Phone:602-412-8335
Practice Address - Fax:480-685-4948
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA218821041C0700X
AZ150571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ332599Medicaid