Individual
DMITRIY KAZAKOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
10 PEARL ST FL 2, PORT CHESTER, NY 10573-4611
(914) 265-2762
Mailing address
10 PEARL ST FL 2, PORT CHESTER, NY 10573-4611
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
2997224
NY
103G00000X
Clinical Neuropsychologist
4127
CT
103TC0700X
Clinical Psychologist
2997224
NY
103TC0700X
Clinical Psychologist
4127
CT
Other
Enumeration date
11/02/2021
Last updated
08/01/2024
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