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General NPI Number Information
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NPI Number | 1023406626
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Entity Type | Organization
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Legal Business Name | AG CHILD AND ADULT PSYCHOLOGY, P.C.
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Dates
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Enumeration Date | 01/05/2015
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Last Update Date | 01/05/2015
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Provider Practice Location Address
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Address Line | 400 S OYSTER BAY RD STE 204
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City | HICKSVILLE
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State | NY
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Zip | 11801-3500
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Country | US
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Telephone | 516-818-8383
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Fax |
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Provider Business Mailing Address
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Address Line | 2 KEEN CT
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City | BROOKLYN
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State | NY
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Zip | 11229-6056
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ALENA GROMOVA
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Credential | PHD
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Telephone | 718-873-6678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0210021
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License Number State | NY
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