Provider Demographics
NPI:1659012839
Name:THE CENTER FOR CHILD AND FAMILY PSYCHIATRY, PC
Entity Type:Organization
Organization Name:THE CENTER FOR CHILD AND FAMILY PSYCHIATRY, PC
Other - Org Name:THE CENTER FOR CHILD AND FAMILY PSYCHIATRY, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALOMOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:646-887-7103
Mailing Address - Street 1:300 N 10TH ST
Mailing Address - Street 2:PO BOX 11
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540-0011
Mailing Address - Country:US
Mailing Address - Phone:254-774-1163
Mailing Address - Fax:254-306-4686
Practice Address - Street 1:1103 N GRAY ST
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-3420
Practice Address - Country:US
Practice Address - Phone:254-774-1163
Practice Address - Fax:254-306-4686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty