1194374827 NPI number — LITTLE SPIRITS LLC

Table of content: (NPI 1194374827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194374827 NPI number — LITTLE SPIRITS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LITTLE SPIRITS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LITTLE SPIRITS LLC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194374827
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
77 N ALMADEN AVE APT 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95110-2776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-612-0673
Provider Business Mailing Address Fax Number:
408-606-9449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 N ALMADEN AVE
Provider Second Line Business Practice Location Address:
STE #102
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-612-0673
Provider Business Practice Location Address Fax Number:
408-606-9449
Provider Enumeration Date:
09/05/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VENEZIA
Authorized Official First Name:
CATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
BEHAVIOR THERAPIST
Authorized Official Telephone Number:
917-612-0673

Provider Taxonomy Codes

  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)