Provider Demographics
NPI:1760790133
Name:GROWING MINDS THERAPEUTICS
Entity Type:Organization
Organization Name:GROWING MINDS THERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:347-270-8522
Mailing Address - Street 1:454 FORT WASHINGTON AVE
Mailing Address - Street 2:#5
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-4650
Mailing Address - Country:US
Mailing Address - Phone:347-270-8522
Mailing Address - Fax:212-927-0789
Practice Address - Street 1:454 FORT WASHINGTON AVE
Practice Address - Street 2:#5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-4650
Practice Address - Country:US
Practice Address - Phone:347-270-8522
Practice Address - Fax:212-927-0789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010349-01251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)