Provider Demographics
NPI:1407092851
Name:FORENSIC PSYCHOLOGY PC
Entity Type:Organization
Organization Name:FORENSIC PSYCHOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:JANOSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-304-5700
Mailing Address - Street 1:75 PLANDOME RD
Mailing Address - Street 2:2ND 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:516-304-5702
Practice Address - Street 1:75 PLANDOME RD
Practice Address - Street 2:2ND 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:516-304-5702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006325103TA0700X, 103TC0700X, 103TC1900X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006325OtherLICENSED PSYCHOLOGIST
NY006325OtherLICENSED PSYCHOLOGIST