Provider Demographics
NPI:1205477239
Name:LITTLE WONDERZ LLC
Entity type:Organization
Organization Name:LITTLE WONDERZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEFAN
Authorized Official - Suffix:
Authorized Official - Credentials:ITDS
Authorized Official - Phone:727-458-0246
Mailing Address - Street 1:10623 ROSEWOOD CT N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-2719
Mailing Address - Country:US
Mailing Address - Phone:727-458-0246
Mailing Address - Fax:727-258-4640
Practice Address - Street 1:10598 ORANGE BLOSSOM LN
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-7503
Practice Address - Country:US
Practice Address - Phone:727-483-1861
Practice Address - Fax:727-258-4640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1831249937OtherNPI
FL1023234846OtherNPI
FL1265793293OtherNPI