Healthcare Provider Details

I. General information

NPI: 1225763709
Provider Name (Legal Business Name): JANUS PSYCHOLOGICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W 56TH ST APT 5J
NEW YORK NY
10019-4316
US

IV. Provider business mailing address

211 W 56TH ST APT 5J
NEW YORK NY
10019-4316
US

V. Phone/Fax

Practice location:
  • Phone: 512-815-3814
  • Fax:
Mailing address:
  • Phone: 512-815-3814
  • Fax: 512-229-9176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANNELISA PEDERSEN
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 512-815-3814