Healthcare Provider Details

I. General information

NPI: 1144773631
Provider Name (Legal Business Name): KIDS IN GROWTH THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2016
Last Update Date: 08/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE ARTERIAL HOSTOS APARTAMENTO N102
SAN JUAN PR
00918-1451
US

IV. Provider business mailing address

PO BOX 1205
BAJADERO PR
00616-1205
US

V. Phone/Fax

Practice location:
  • Phone: 939-642-5607
  • Fax:
Mailing address:
  • Phone: 939-642-5607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number3849
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number3849
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number3849
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4232
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number971
License Number StatePR
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: MISS EUNICE N VELEZ
Title or Position: TERAPISTA DEL HABLA Y LENGUAJE
Credential: LICENSE
Phone: 939-942-5607