Provider Demographics
NPI:1447328448
Name:MIHOVICH, EVA G (PHD)
Entity type:Individual
Prefix:DR
First Name:EVA
Middle Name:G
Last Name:MIHOVICH
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 1:502 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4103
Mailing Address - Country:US
Mailing Address - Phone:718-768-9192
Mailing Address - Fax:718-768-9192
Practice Address - Street 1:502 9TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4103
Practice Address - Country:US
Practice Address - Phone:718-768-9192
Practice Address - Fax:718-768-9192
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007053-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00953324Medicaid
NYV64641Medicare ID - Type Unspecified