Provider Demographics
NPI:1194955526
Name:DUBROVSKY, BORIS (PHD,CBSM,DBSM,RPSGT)
Entity type:Individual
Prefix:DR
First Name:BORIS
Middle Name:
Last Name:DUBROVSKY
Suffix:
Gender:M
Credentials:PHD,CBSM,DBSM,RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3675
Mailing Address - Country:US
Mailing Address - Phone:718-780-3017
Mailing Address - Fax:718-780-6711
Practice Address - Street 1:519 6TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3608
Practice Address - Country:US
Practice Address - Phone:718-780-3017
Practice Address - Fax:718-780-6711
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018170103T00000X
NY11039246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other