Provider Demographics
NPI:1720569221
Name:EMPOWERED KIDS LLC
Entity Type:Organization
Organization Name:EMPOWERED KIDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PROUTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-636-3719
Mailing Address - Street 1:167 PROSPECT STREET EXT
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-1567
Mailing Address - Country:US
Mailing Address - Phone:413-636-3719
Mailing Address - Fax:
Practice Address - Street 1:167 PROSPECT STREET EXT
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-1567
Practice Address - Country:US
Practice Address - Phone:413-636-3719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2236103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty