Provider Demographics
NPI:1023406626
Name:AG CHILD AND ADULT PSYCHOLOGY, P.C.
Entity type:Organization
Organization Name:AG CHILD AND ADULT PSYCHOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALENA
Authorized Official - Middle Name:
Authorized Official - Last Name:GROMOVA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:718-873-6678
Mailing Address - Street 1:2 KEEN CT
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-6056
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 S OYSTER BAY RD
Practice Address - Street 2:STE 204
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3500
Practice Address - Country:US
Practice Address - Phone:516-818-8383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0210021103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty