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General NPI Number Information
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NPI Number | 1518196104
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Entity Type | Organization
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Legal Business Name | GROWING ROOTS LLC
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Dates
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Enumeration Date | 07/06/2009
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Last Update Date | 08/25/2009
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Provider Practice Location Address
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Address Line | 85 MAIN ST SUITE 305
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City | PLYMOUTH
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State | NH
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Zip | 03264-1500
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Country | US
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Telephone | 603-238-3149
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Fax |
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Provider Business Mailing Address
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Address Line | 85 MAIN ST SUITE 305
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City | PLYMOUTH
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State | NH
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Zip | 03264-1500
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Country | US
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Telephone | 603-238-3149
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL PSYCHOLOGIST / OWNER
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Name | DR. SCOTT ALLEN SCHINAMAN
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Credential | PSY.D.
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Telephone | 603-238-3149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1166
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License Number State | NH
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