| Organization Name: | GENTLE GROWTH THERAPEUTIC SERVICES, LCSW, PLLC |
| NPI Number: | 1093952301 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LETITIA VICTORIA COBURN (SOLE PROPRIETOR) |
| Mailing Address: | 29 Marble Ave 2nd Floor Pleasantville |
| State: | NY US |
| Postal Code: | 105702956 |
| Phone Number: | 9149440422 |
| Fax Number: | 9149440422 |
| NPI Enumeration Date: | 01/08/2009 |
| NPI Last Update Date: | 03/02/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0850X |
| License Number: | LCSW 052250 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Adult Mental Health |
| Taxonomy Definition: | An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |