Healthcare Provider Details

I. General information

NPI: 1407092851
Provider Name (Legal Business Name): FORENSIC PSYCHOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 PLANDOME RD 2ND FLOOR
MANHASSET NY
11030-2301
US

IV. Provider business mailing address

75 PLANDOME RD 2ND FLOOR
MANHASSET NY
11030-2301
US

V. Phone/Fax

Practice location:
  • Phone: 516-304-5700
  • Fax: 516-304-5702
Mailing address:
  • Phone: 516-304-5700
  • Fax: 516-304-5702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number006325
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number006325
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number006325
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number006325
License Number StateNY

VIII. Authorized Official

Name: MARC A JANOSON
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 516-304-5700