Provider Demographics
NPI:1184022535
Name:LEAP YEARS SERVICES FOR CHILDREN
Entity Type:Organization
Organization Name:LEAP YEARS SERVICES FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPANJOL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA-D, LMHC
Authorized Official - Phone:917-536-6728
Mailing Address - Street 1:215 W 90TH ST
Mailing Address - Street 2:1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1221
Mailing Address - Country:US
Mailing Address - Phone:917-536-6728
Mailing Address - Fax:
Practice Address - Street 1:215 W 90TH ST
Practice Address - Street 2:1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1221
Practice Address - Country:US
Practice Address - Phone:917-536-6728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005431101YM0800X
NY000055103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty