Provider Demographics
NPI:1760156814
Name:GROWTH WELLNESS SERVICES LCSW, PLLC
Entity Type:Organization
Organization Name:GROWTH WELLNESS SERVICES LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:TOYAE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVERPOOL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:914-595-6682
Mailing Address - Street 1:54 MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-3660
Mailing Address - Country:US
Mailing Address - Phone:914-595-6682
Mailing Address - Fax:
Practice Address - Street 1:54 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-3660
Practice Address - Country:US
Practice Address - Phone:914-595-6682
Practice Address - Fax:914-595-4236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-03
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06568827Medicaid