Provider Demographics
NPI:1770732158
Name:KIDS PLAY THERAPY LLC
Entity type:Organization
Organization Name:KIDS PLAY THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:XERISS
Authorized Official - Middle Name:JOANAH
Authorized Official - Last Name:SANTA ANA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:917-822-6461
Mailing Address - Street 1:209 MURRAY AVE
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-1205
Mailing Address - Country:US
Mailing Address - Phone:917-822-6461
Mailing Address - Fax:
Practice Address - Street 1:209 MURRAY AVE
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-1205
Practice Address - Country:US
Practice Address - Phone:917-822-6461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008688-1320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities