Healthcare Provider Details

I. General information

NPI: 1740010297
Provider Name (Legal Business Name): LEAP-LIFELONG EMPOWERMENT ABA & PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 FOREST PARK DR STE 2-2-LM
FARMINGTON CT
06032-1445
US

IV. Provider business mailing address

2 FOREST PARK DR STE 2-2-LM
FARMINGTON CT
06032-1445
US

V. Phone/Fax

Practice location:
  • Phone: 860-383-7090
  • Fax: 860-968-8667
Mailing address:
  • Phone: 860-383-7090
  • Fax: 860-968-8667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: AMANDA CORETTO
Title or Position: OWNER
Credential: LPC
Phone: 860-986-1496