Provider Demographics
NPI:1073058467
Name:RAPHAELIDIS, JANUS (BCBA, LBA)
Entity Type:Individual
Prefix:MR
First Name:JANUS
Middle Name:
Last Name:RAPHAELIDIS
Suffix:
Gender:M
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 SELWYN DR APT 2B
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4574
Mailing Address - Country:US
Mailing Address - Phone:443-293-2314
Mailing Address - Fax:
Practice Address - Street 1:9133 LIBERTY VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:UNION BRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21791
Practice Address - Country:US
Practice Address - Phone:443-293-2314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-21
Last Update Date:2018-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0000000000000000000106S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician