Provider Demographics
NPI:1750916177
Name:ASSESSMENT AND DEVELOPMENT CENTER OF SACRAMENTO
Entity type:Organization
Organization Name:ASSESSMENT AND DEVELOPMENT CENTER OF SACRAMENTO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SHIBA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHIMI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:916-969-7588
Mailing Address - Street 1:1555 RIVER PARK DR STE 103
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4603
Mailing Address - Country:US
Mailing Address - Phone:916-692-8837
Mailing Address - Fax:
Practice Address - Street 1:1555 RIVER PARK DR STE 103
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4603
Practice Address - Country:US
Practice Address - Phone:916-692-8837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty