Provider Demographics
NPI:1497234876
Name:ENLIGHTENED KIDS ABA/SI SERVICES
Entity Type:Organization
Organization Name:ENLIGHTENED KIDS ABA/SI SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SP ED TEACHER/ABA/SI THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NATALYA
Authorized Official - Middle Name:G
Authorized Official - Last Name:EDWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MS ED, MSSPED
Authorized Official - Phone:917-770-2526
Mailing Address - Street 1:440 NEPTUNE AVE APT 22G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-4453
Mailing Address - Country:US
Mailing Address - Phone:917-770-2526
Mailing Address - Fax:
Practice Address - Street 1:440 NEPTUNE AVE APT 22G
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-4453
Practice Address - Country:US
Practice Address - Phone:917-770-2526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1320938252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency