Provider Demographics
NPI:1891416210
Name:PROGRESS 2 SUCCESS LLC
Entity Type:Organization
Organization Name:PROGRESS 2 SUCCESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:SIM
Authorized Official - Middle Name:
Authorized Official - Last Name:B
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-977-7095
Mailing Address - Street 1:286 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NY
Mailing Address - Zip Code:12754-2014
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:286 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-2014
Practice Address - Country:US
Practice Address - Phone:347-977-7095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-05
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty