Healthcare Provider Details

I. General information

NPI: 1063928372
Provider Name (Legal Business Name): AURORA PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 12/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 PROSPECT PL
BROOKLYN NY
11217-2804
US

IV. Provider business mailing address

92 PROSPECT PL
BROOKLYN NY
11217-2804
US

V. Phone/Fax

Practice location:
  • Phone: 347-770-7631
  • Fax:
Mailing address:
  • Phone: 347-770-7631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number020920-1
License Number StateNY

VIII. Authorized Official

Name: DR. DIANA MOROZOV
Title or Position: DIRECTOR
Credential: PSY.D.
Phone: 347-770-7631