| Organization Name: | AG CHILD AND ADULT PSYCHOLOGY, P.C. |
| NPI Number: | 1023406626 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ALENA GROMOVA (DIRECTOR) |
| Mailing Address: | 400 S Oyster Bay Rd Ste 204 Hicksville |
| State: | NY US |
| Postal Code: | 118013500 |
| Phone Number: | 5168188383 |
| Fax Number: | |
| NPI Enumeration Date: | 01/05/2015 |
| NPI Last Update Date: | 01/05/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 0210021 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |