MEDICARE: AUTISM REC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	251V00000X	Voluntary or Charitable Agency
3	261QD1600X	Developmental Disabilities Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245973593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUTISM REC

Provider Business Mailing Address
First Line	:	PO BOX 605
Second Line	:
City	:	DARBY
State	:	PA
Zip	:	19023-0605
Country	:	US
Telephone Number	:	215-200-0405
Fax Number	:

Provider Business Practice Location Address
First Line	:	1140 S 26TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-3849
Country	:	US
Telephone Number	:	215-200-0405
Fax Number	:

Authorized Official
Title or Position	:	SPEECH THERAPIST
Name	:	JACQUELINE LACINSKI
Credential	:	MA, CCC-SLP
Telephone Number	:	484-326-9900

Provider Enumeration Date	:	04/14/2022
Last Update Date	:	04/14/2022

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Directions to “AUTISM REC ” Practice Location

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