MEDICARE: GROW TIME THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1497458723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROW TIME THERAPY LLC

Provider Business Mailing Address
First Line	:	2227 US HIGHWAY 1 STE 254
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-4402
Country	:	US
Telephone Number	:	732-762-7133
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 PEMBROOK AVE
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-4292
Country	:	US
Telephone Number	:	732-762-7133
Fax Number	:

Authorized Official
Title or Position	:	BEHAVIOR ANALYST
Name	:	MS. RAVEN ADKINS
Credential	:	BCBA
Telephone Number	:	732-762-7133

Provider Enumeration Date	:	03/24/2023
Last Update Date	:	08/20/2023

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