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General NPI Number Information
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NPI Number | 1568052587
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Entity Type | Organization
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Legal Business Name | GROWING MINDS PSYCHOLOGY
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Dates
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Enumeration Date | 01/23/2021
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Last Update Date | 11/04/2021
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Provider Practice Location Address
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Address Line | 414 E 75TH ST FL 4
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City | NEW YORK
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State | NY
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Zip | 10021-3442
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Country | US
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Telephone | 646-494-3791
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Fax |
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Provider Business Mailing Address
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Address Line | 414 E 75TH ST FL 4
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City | NEW YORK
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State | NY
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Zip | 10021-3442
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Country | US
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Telephone | 646-494-3791
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF NEUROPSYCHOLOGY
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Name | DR. MATTHEW PAGIRSKY
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Credential | PSYD
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Telephone | 646-494-6149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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