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General NPI Number Information
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NPI Number | 1063347144
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Entity Type | Organization
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Legal Business Name | THE GROWING VILLAGE
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Dates
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Enumeration Date | 06/17/2026
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Last Update Date | 06/17/2026
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Provider Practice Location Address
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Address Line | 4 MINTHORNE ST
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City | STATEN ISLAND
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State | NY
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Zip | 10301-3241
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Country | US
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Telephone | 347-885-3004
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Fax |
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Provider Business Mailing Address
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Address Line | 82 ARLO RD APT 1B
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City | STATEN ISLAND
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State | NY
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Zip | 10301-3879
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Country | US
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Telephone | 347-885-3004
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Fax |
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Authorized Official
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Title or Position | SPECIAL EDUCATION
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Name | TRACEY WATLER
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Credential | MD
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Telephone | 347-885-3004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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