Healthcare Provider Details

I. General information

NPI: 1386344653
Provider Name (Legal Business Name): GROWTHSPACE PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1382 BEACON ST APT 15
BROOKLINE MA
02446-2875
US

IV. Provider business mailing address

1382 BEACON ST APT 15
BROOKLINE MA
02446-2875
US

V. Phone/Fax

Practice location:
  • Phone: 773-259-3995
  • Fax:
Mailing address:
  • Phone: 773-259-3995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. TRACEE JOY FRANCIS
Title or Position: FOUNDER & CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 773-259-3995