Provider Demographics
NPI:1639321730
Name:LISE PETRICONE INC. DBA SMALL STEPS
Entity Type:Organization
Organization Name:LISE PETRICONE INC. DBA SMALL STEPS
Other - Org Name:SMALL STEPS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRICONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-353-2350
Mailing Address - Street 1:21 BURD ST
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-3205
Mailing Address - Country:US
Mailing Address - Phone:845-353-2350
Mailing Address - Fax:845-353-2397
Practice Address - Street 1:21 BURD ST
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-3205
Practice Address - Country:US
Practice Address - Phone:845-353-2350
Practice Address - Fax:845-353-2397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251300000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251300000XAgenciesLocal Education Agency (LEA)