Provider Demographics
NPI:1093952301
Name:GENTLE GROWTH THERAPEUTIC SERVICES, PLLC, LCSW
Entity Type:Organization
Organization Name:GENTLE GROWTH THERAPEUTIC SERVICES, PLLC, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LETITIA
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:COBURN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:914-471-2632
Mailing Address - Street 1:1872 PLEASANTVILLE ROAD, #129
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510
Mailing Address - Country:US
Mailing Address - Phone:914-471-2632
Mailing Address - Fax:914-944-0595
Practice Address - Street 1:522 NORTH STATE ROAD
Practice Address - Street 2:#202
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510
Practice Address - Country:US
Practice Address - Phone:914-471-2632
Practice Address - Fax:914-944-0595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLCSW 052250261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health