Provider Demographics
NPI:1417261306
Name:SEROVA, SVETLANA (PHD)
Entity type:Individual
Prefix:DR
First Name:SVETLANA
Middle Name:
Last Name:SEROVA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 BEVERLEY RD
Mailing Address - Street 2:APT 1V
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3154
Mailing Address - Country:US
Mailing Address - Phone:212-824-7630
Mailing Address - Fax:212-426-4973
Practice Address - Street 1:1651 3RD AVE
Practice Address - Street 2:RM 205
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3679
Practice Address - Country:US
Practice Address - Phone:940-231-1742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68018554103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist