Provider Demographics
NPI:1407294580
Name:POPOVICH HYMOWITZ, GENNA FAITH (PHD)
Entity Type:Individual
Prefix:DR
First Name:GENNA
Middle Name:FAITH
Last Name:POPOVICH HYMOWITZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:GENNA
Other - Middle Name:FAITH
Other - Last Name:HYMOWITZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:469 PSYCHOLOGY BLDG B
Mailing Address - Street 2:DEPARTMENT OF PSYCHOLOGY, STONY BROOK UNIVERSITY
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-2520
Mailing Address - Country:US
Mailing Address - Phone:631-632-4954
Mailing Address - Fax:
Practice Address - Street 1:469 PSYCHOLOGY BLDG B
Practice Address - Street 2:DEPARTMENT OF PSYCHOLOGY, STONY BROOK UNIVERSITY
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-2520
Practice Address - Country:US
Practice Address - Phone:631-632-4954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020105103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical