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General NPI Number Information
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NPI Number | 1114289030
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Entity Type | Organization
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Legal Business Name | GROWTH AND DEVELOPMENT BEHAVIORAL MANAGEMENT INC.
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Dates
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Enumeration Date | 06/15/2012
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 86 SCHLEIGEL BLVD
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City | FARMINGDALE
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State | NY
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Zip | 11735-6256
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Country | US
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Telephone | 631-391-0198
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Fax |
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Provider Business Mailing Address
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Address Line | 86 SCHLEIGEL BLVD
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City | FARMINGDALE
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State | NY
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Zip | 11735-6256
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Country | US
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Telephone | 632-391-0198
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. KAREN SACHS
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Credential | MSED
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Telephone | 631-391-0198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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