Healthcare Provider Details

I. General information

NPI: 1851104376
Provider Name (Legal Business Name): PLAY LEARN GROW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/29/2025
Certification Date: 01/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 MAIN ST 8TH FLOOR
SPRINGFIELD MA
01115
US

IV. Provider business mailing address

10 FOSTER RD
SOUTHWICK MA
01077-9536
US

V. Phone/Fax

Practice location:
  • Phone: 413-427-8179
  • Fax: 413-515-9650
Mailing address:
  • Phone: 413-427-8179
  • Fax: 413-515-9650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: OLGA MORENO
Title or Position: BEHAVIOR ANALYST
Credential: BCBA, LABA
Phone: 413-427-8179