Provider Demographics
NPI:1629474366
Name:GROWING MINDS, LLC
Entity Type:Organization
Organization Name:GROWING MINDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANYA
Authorized Official - Middle Name:SHIFMAN
Authorized Official - Last Name:DASHEVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:339-970-0659
Mailing Address - Street 1:4 MILITIA DR
Mailing Address - Street 2:SUITE 17
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-4737
Mailing Address - Country:US
Mailing Address - Phone:339-970-0659
Mailing Address - Fax:
Practice Address - Street 1:4 MILITIA DR
Practice Address - Street 2:SUITE 17
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-4737
Practice Address - Country:US
Practice Address - Phone:339-970-0659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty