Provider Demographics
NPI:1124489638
Name:PROSPECT KIDS, LLC
Entity type:Organization
Organization Name:PROSPECT KIDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEKSANDR
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLMACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-921-3250
Mailing Address - Street 1:2102 AVENUE Z
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2812
Mailing Address - Country:US
Mailing Address - Phone:347-921-3250
Mailing Address - Fax:347-779-0433
Practice Address - Street 1:2102 AVENUE Z
Practice Address - Street 2:SUITE 304
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2812
Practice Address - Country:US
Practice Address - Phone:718-351-6248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-10
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health