Provider Demographics
NPI:1962758946
Name:KIDS LEARNING LOFT ABA SERVICES, PLLC
Entity type:Organization
Organization Name:KIDS LEARNING LOFT ABA SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KOURASSANIS-VELASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-741-0729
Mailing Address - Street 1:305 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-2102
Mailing Address - Country:US
Mailing Address - Phone:516-741-0729
Mailing Address - Fax:
Practice Address - Street 1:436 WILLIS AVE STE 3
Practice Address - Street 2:
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-2298
Practice Address - Country:US
Practice Address - Phone:516-741-0729
Practice Address - Fax:516-209-4556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty