Provider Demographics
NPI:1518219831
Name:JANOSON FORENSIC PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:JANOSON FORENSIC PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:JANOSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-304-5700
Mailing Address - Street 1:75 PLANDOME ROAD
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-2301
Mailing Address - Country:US
Mailing Address - Phone:516-304-5700
Mailing Address - Fax:516-304-5701
Practice Address - Street 1:75 PLANDOME ROAD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-2301
Practice Address - Country:US
Practice Address - Phone:516-304-5700
Practice Address - Fax:516-304-5701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006325103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty