Provider Demographics
NPI:1265129480
Name:GROWING ROOTS TO OPEN WINGS INC
Entity type:Organization
Organization Name:GROWING ROOTS TO OPEN WINGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-475-0805
Mailing Address - Street 1:10 COREY ST APT 104
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-4674
Mailing Address - Country:US
Mailing Address - Phone:617-347-8210
Mailing Address - Fax:
Practice Address - Street 1:4238 WASHINGTON ST STE 409
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02131-2558
Practice Address - Country:US
Practice Address - Phone:617-475-0805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty