Dmitri Bougakov PH.D. Psychology PLLC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

017107 Issued in NY

Legal business name

DMITRI BOUGAKOV PH.D. PSYCHOLOGY PLLC

Practice address

315 W 57TH St
Suite 401
New York, NY 10019-3158

Phone

(212) 541-6412

NPI assigned

Feb 12, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Dmitri Bougakov, PH.D.

Title

Sole Proprietor

Phone

(646) 496-8963

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1234396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234396800000",
    "number": "1326287426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 E MOSHOLU PKWY S",
            "address_2": "APARTMENT 6G",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104581742",
            "telephone_number": "646-496-8963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 W 57TH ST",
            "address_2": "SUITE 401",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100193158",
            "telephone_number": "212-541-6412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DMITRI BOUGAKOV PH.D. PSYCHOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-12",
        "last_updated": "2009-02-12",
        "status": "A",
        "authorized_official_last_name": "BOUGAKOV",
        "authorized_official_first_name": "DMITRI",
        "authorized_official_title_or_position": "SOLE PROPRIETOR",
        "authorized_official_telephone_number": "646-496-8963",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "NY",
            "license": "017107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Neuropsychologist in New York, NY
• Providers in New York, NY by specialty
• Clinical Neuropsychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.