MEDICARE: SHAHLA GOROVOY PSYCHOLOGIST PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1689482929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAHLA GOROVOY PSYCHOLOGIST PC

Provider Business Mailing Address
First Line	:	180 PINE TREE RD
Second Line	:
City	:	MONROE
State	:	NY
Zip	:	10950-3964
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 DOLSON AVE STE 206A
Second Line	:
City	:	MIDDLETOWN
State	:	NY
Zip	:	10940-6570
Country	:	US
Telephone Number	:	845-342-6461
Fax Number	:	845-299-2984

Authorized Official
Title or Position	:	OWNER
Name	:	SHAHLA GOROVOY
Credential	:	PHD
Telephone Number	:	845-325-6202

Provider Enumeration Date	:	12/19/2024
Last Update Date	:	05/28/2025

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