Provider Demographics
NPI:1205418191
Name:DEVELOPMENTAL GROWTH LLC
Entity Type:Organization
Organization Name:DEVELOPMENTAL GROWTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIRTZA
Authorized Official - Middle Name:
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-536-0255
Mailing Address - Street 1:1 HUNTER DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4755
Mailing Address - Country:US
Mailing Address - Phone:201-249-0048
Mailing Address - Fax:
Practice Address - Street 1:1 HUNTER DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4755
Practice Address - Country:US
Practice Address - Phone:201-249-0048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty