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General NPI Number Information
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NPI Number | 1518744846
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Entity Type | Organization
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Legal Business Name | GROWTH OUTPATIENT MENTAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 09/11/2023
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 485C US HIGHWAY 1 S STE 100-36
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City | ISELIN
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State | NJ
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Zip | 08830-3037
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Country | US
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Telephone | 732-844-3424
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 392
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City | AVENEL
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State | NJ
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Zip | 07001-0392
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Country | US
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Telephone | 732-844-3424
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Fax | 732-621-8342
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Authorized Official
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Title or Position | OWNER/ PSYCHIATRIC PROVIDER
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Name | SAMIRAH BOSTIC
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Credential |
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Telephone | 732-844-3424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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