Healthcare Provider Details

I. General information

NPI: 1184233371
Provider Name (Legal Business Name): KRISTINA AGANOVA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 BEECH ST APT 2H
HACKENSACK NJ
07601-2137
US

IV. Provider business mailing address

301 BEECH ST APT 2H
HACKENSACK NJ
07601-2137
US

V. Phone/Fax

Practice location:
  • Phone: 646-206-4548
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number026831
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35SI00769600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: