Healthcare Provider Details

I. General information

NPI: 1689482929
Provider Name (Legal Business Name): SHAHLA GOROVOY PSYCHOLOGIST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 DOLSON AVE STE 206A
MIDDLETOWN NY
10940-6570
US

IV. Provider business mailing address

180 PINE TREE RD
MONROE NY
10950-3964
US

V. Phone/Fax

Practice location:
  • Phone: 845-342-6461
  • Fax: 845-299-2984
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHAHLA GOROVOY
Title or Position: OWNER
Credential: PHD
Phone: 845-325-6202