Provider Demographics
NPI:1194374827
Name:LITTLE SPIRITS LLC
Entity Type:Organization
Organization Name:LITTLE SPIRITS LLC
Other - Org Name:LITTLE SPIRITS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BEHAVIOR THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:VENEZIA
Authorized Official - Suffix:
Authorized Official - Credentials:MSED, BCBA
Authorized Official - Phone:917-612-0673
Mailing Address - Street 1:77 N ALMADEN AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95110-2776
Mailing Address - Country:US
Mailing Address - Phone:917-612-0673
Mailing Address - Fax:408-606-9449
Practice Address - Street 1:77 N ALMADEN AVE
Practice Address - Street 2:STE #102
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110
Practice Address - Country:US
Practice Address - Phone:917-612-0673
Practice Address - Fax:408-606-9449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-05
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health