Provider Demographics
NPI:1194758466
Name:RABENOU, BIJAN (PH D)
Entity type:Individual
Prefix:DR
First Name:BIJAN
Middle Name:
Last Name:RABENOU
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8421 122ND ST
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-3233
Mailing Address - Country:US
Mailing Address - Phone:347-651-5130
Mailing Address - Fax:718-847-3808
Practice Address - Street 1:50 COURT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4859
Practice Address - Country:US
Practice Address - Phone:718-855-7707
Practice Address - Fax:718-855-7717
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007089-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist