Provider Demographics
NPI:1740010297
Name:LEAP-LIFELONG EMPOWERMENT ABA & PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:LEAP-LIFELONG EMPOWERMENT ABA & PSYCHOTHERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORETTO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-986-1496
Mailing Address - Street 1:2 FOREST PARK DR STE 2-2-LM
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1445
Mailing Address - Country:US
Mailing Address - Phone:860-383-7090
Mailing Address - Fax:860-968-8667
Practice Address - Street 1:2 FOREST PARK DR STE 2-2-LM
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1445
Practice Address - Country:US
Practice Address - Phone:860-383-7090
Practice Address - Fax:860-968-8667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-07
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1043801491Medicaid