Provider Demographics
NPI:1871841445
Name:KID SUCCESS, INC.
Entity type:Organization
Organization Name:KID SUCCESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LA FATA
Authorized Official - Suffix:
Authorized Official - Credentials:MS ED
Authorized Official - Phone:516-796-0989
Mailing Address - Street 1:2950 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1383
Mailing Address - Country:US
Mailing Address - Phone:516-796-0989
Mailing Address - Fax:
Practice Address - Street 1:2950 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1383
Practice Address - Country:US
Practice Address - Phone:516-796-0989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-12-11976251S00000X
NY740983251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health