Basic Information
| Provider Information | |||||||||
| NPI: | 1992092654 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LITTLE LEAVES BEHAVIOR THERAPIES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9545 GEORGIA AVE | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209101438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024208359 | ||||||||
| FaxNumber: | 2023182351 | ||||||||
| Practice Location | |||||||||
| Address1: | 9545 GEORGIA AVE | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209101438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024208359 | ||||||||
| FaxNumber: | 2023182351 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2011 | ||||||||
| LastUpdateDate: | 05/12/2015 | ||||||||
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| AuthorizedOfficialLastName: | MAJOR | ||||||||
| AuthorizedOfficialFirstName: | MARINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2023900120 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 4416 | MD | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103K00000X | 1-03-1325 | MD | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.