Provider Demographics
NPI:1134443187
Name:JANUS, RAIZI ABBY (PHD)
Entity type:Individual
Prefix:DR
First Name:RAIZI
Middle Name:ABBY
Last Name:JANUS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:RAIZI
Other - Middle Name:
Other - Last Name:SHOOP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:150 BETHLEHEM RD.
Mailing Address - Street 2:PO BOX 94
Mailing Address - City:CALLICOON CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:12724-0094
Mailing Address - Country:US
Mailing Address - Phone:914-245-3780
Mailing Address - Fax:845-482-4901
Practice Address - Street 1:150 BETHLEHEM RD.
Practice Address - Street 2:
Practice Address - City:CALLICOON CENTER
Practice Address - State:NY
Practice Address - Zip Code:12724-0094
Practice Address - Country:US
Practice Address - Phone:914-245-3780
Practice Address - Fax:845-482-4901
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011510-1103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral