Provider Demographics
NPI:1255005799
Name:WHERE LITTLE MINDS GROW LLC
Entity Type:Organization
Organization Name:WHERE LITTLE MINDS GROW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RESTIVO-BARATTA
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:718-689-2795
Mailing Address - Street 1:7 ROGERS PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-4119
Mailing Address - Country:US
Mailing Address - Phone:718-689-2795
Mailing Address - Fax:
Practice Address - Street 1:7 ROGERS PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-4119
Practice Address - Country:US
Practice Address - Phone:718-689-2795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-08
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05818837Medicaid