Provider Demographics
NPI:1093499816
Name:TINY TOTS SPECIALIZED CONSULTING SERVICES LLC
Entity Type:Organization
Organization Name:TINY TOTS SPECIALIZED CONSULTING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:FABER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:646-541-4245
Mailing Address - Street 1:7 VIA DE CASAS SUR APT 102
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8870
Mailing Address - Country:US
Mailing Address - Phone:646-541-4245
Mailing Address - Fax:
Practice Address - Street 1:7 VIA DE CASAS SUR APT 102
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8870
Practice Address - Country:US
Practice Address - Phone:646-541-4245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2023-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118457800Medicaid