Organization
DMITRI BOUGAKOV PH.D. PSYCHOLOGY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DMITRI BOUGAKOV PH.D. (SOLE PROPRIETOR)
(646) 496-8963
Entity
Organization
Contact information
Practice address
315 W 57TH ST, SUITE 401, NEW YORK, NY 10019-3158
(212) 541-6412
Mailing address
340 E MOSHOLU PKWY S, APARTMENT 6G, BRONX, NY 10458-1742
(646) 496-8963
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
017107
NY
Other
Enumeration date
02/12/2009
Last updated
02/12/2009
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