| Leap-lifelong Empowerment Aba & Psychotherapy Llc | |
|
2 Forest Park Dr Ste 2-2-lm Farmington CT 06032-1445 | |
| (860) 383-7090 | |
| (860) 968-8667 |
| Full Name | Leap-lifelong Empowerment Aba & Psychotherapy Llc |
|---|---|
| Speciality | Counselor |
| Location | 2 Forest Park Dr Ste 2-2-lm, Farmington, Connecticut |
| Authorized Official Name and Position | Amanda Coretto (OWNER) |
| Authorized Official Contact | 8609861496 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Leap-lifelong Empowerment Aba & Psychotherapy Llc 2 Forest Park Dr Ste 2-2-lm Farmington CT 06032-1445 Ph: (860) 383-7090 | Leap-lifelong Empowerment Aba & Psychotherapy Llc 2 Forest Park Dr Ste 2-2-lm Farmington CT 06032-1445 Ph: (860) 383-7090 |
| NPI Number | 1740010297 |
|---|---|
| Provider Enumeration Date | 08/07/2024 |
| Last Update Date | 03/18/2025 |
| Certification Date | 03/18/2025 |
| Medicare PECOS PAC ID | 3577093012 |
|---|---|
| Medicare Enrollment ID | O20250212003124 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740010297 | NPI | - | NPPES |
| 1043801491 | Medicaid | CT |
| Provider Name | Brandy Lee Craig |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1366691545 PECOS PAC ID: 0749710291 Enrollment ID: I20250212003182 |
| Provider Name | Amanda Coretto |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043801491 PECOS PAC ID: 9537699020 Enrollment ID: I20250213001209 |
| Provider Name | Steven Wasilewski |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1952552564 PECOS PAC ID: 0941720775 Enrollment ID: I20250225000451 |
| Provider Name | Amy L Rickett |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1215750179 PECOS PAC ID: 5294255840 Enrollment ID: I20250226000441 |
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