Provider Demographics
NPI:1750504635
Name:RABINOR, JUDITH R (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:R
Last Name:RABINOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 BIARRITZ ST
Mailing Address - Street 2:
Mailing Address - City:LIDO BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-5102
Mailing Address - Country:US
Mailing Address - Phone:516-889-3404
Mailing Address - Fax:
Practice Address - Street 1:36 BIARRITZ ST
Practice Address - Street 2:
Practice Address - City:LIDO BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-5102
Practice Address - Country:US
Practice Address - Phone:516-889-3404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7174103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)