Provider Demographics
NPI:1821755158
Name:GROWING STAGES MARRIAGE AND FAMILY THERAPY PLLC
Entity Type:Organization
Organization Name:GROWING STAGES MARRIAGE AND FAMILY THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SHERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-278-1044
Mailing Address - Street 1:43 WESTCHESTER SQ STE 3
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3551
Mailing Address - Country:US
Mailing Address - Phone:347-278-1044
Mailing Address - Fax:
Practice Address - Street 1:43 WESTCHESTER SQ STE 3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3551
Practice Address - Country:US
Practice Address - Phone:347-278-1044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty