Healthcare Provider Details

I. General information

NPI: 1518590116
Provider Name (Legal Business Name): THE GROWING TREE INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 07/27/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 MAIN ST STE 2
ELLINGTON CT
06029-3361
US

IV. Provider business mailing address

12 MAIN ST STE 2
ELLINGTON CT
06029-3361
US

V. Phone/Fax

Practice location:
  • Phone: 860-730-4176
  • Fax: 860-469-2714
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE WOOD
Title or Position: BUSINESS MANAGER
Credential:
Phone: 860-712-4550