Basic Information
| Provider Information | |||||||||
| NPI: | 1194758466 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RABENOU | ||||||||
| FirstName: | BIJAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH. D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8421 122ND ST | ||||||||
| Address2: | |||||||||
| City: | KEW GARDENS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114153233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3476515130 | ||||||||
| FaxNumber: | 7188473808 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 COURT ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112014859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188557707 | ||||||||
| FaxNumber: | 7188557717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 007089-1 | NY | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.