Provider Demographics
NPI:1144773631
Name:KIDS IN GROWTH THERAPY INC
Entity Type:Organization
Organization Name:KIDS IN GROWTH THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TERAPISTA DEL HABLA Y LENGUAJE
Authorized Official - Prefix:MISS
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:N
Authorized Official - Last Name:VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSE
Authorized Official - Phone:939-942-5607
Mailing Address - Street 1:PO BOX 1205
Mailing Address - Street 2:
Mailing Address - City:BAJADERO
Mailing Address - State:PR
Mailing Address - Zip Code:00616-1205
Mailing Address - Country:US
Mailing Address - Phone:939-642-5607
Mailing Address - Fax:
Practice Address - Street 1:AVE ARTERIAL HOSTOS
Practice Address - Street 2:APARTAMENTO N102
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-1451
Practice Address - Country:US
Practice Address - Phone:939-642-5607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3849103TB0200X, 103TC2200X, 103TM1800X
PR4232103TS0200X
PR9712355S0801X
235Z00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherMEDICAL PLAN