Healthcare Provider Details

I. General information

NPI: 1063347144
Provider Name (Legal Business Name): THE GROWING VILLAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MINTHORNE ST
STATEN ISLAND NY
10301-3241
US

IV. Provider business mailing address

82 ARLO RD APT 1B
STATEN ISLAND NY
10301-3879
US

V. Phone/Fax

Practice location:
  • Phone: 347-885-3004
  • Fax:
Mailing address:
  • Phone: 347-885-3004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: TRACEY WATLER
Title or Position: SPECIAL EDUCATION
Credential: MD
Phone: 347-885-3004