Provider Demographics
NPI:1609512250
Name:RAZ, FLORENCIA BERNTHAL (LP)
Entity Type:Individual
Prefix:
First Name:FLORENCIA
Middle Name:BERNTHAL
Last Name:RAZ
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:FLORENCIA
Other - Middle Name:
Other - Last Name:BERNTHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:99 AVENUE B # 2DE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-6210
Mailing Address - Country:US
Mailing Address - Phone:646-831-2786
Mailing Address - Fax:
Practice Address - Street 1:220 5TH AVE FL 11
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-8017
Practice Address - Country:US
Practice Address - Phone:646-831-2786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001125-01102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst