MEDICARE: CLARITY AUTISM CENTER FOR DIAGNOSTIC EVALUATIONS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1336915685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARITY AUTISM CENTER FOR DIAGNOSTIC EVALUATIONS LLC

Provider Business Mailing Address
First Line	:	411 STATE RT 17 STE 500
Second Line	:
City	:	HASBROUCK HEIGHTS
State	:	NJ
Zip	:	07604-3016
Country	:	US
Telephone Number	:	347-971-0039
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 STATE RT 17 STE 500
Second Line	:
City	:	HASBROUCK HEIGHTS
State	:	NJ
Zip	:	07604-3016
Country	:	US
Telephone Number	:	347-971-0039
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MIRIAM LICHTSCHEIN
Credential	:
Telephone Number	:	347-971-0039

Provider Enumeration Date	:	11/28/2023
Last Update Date	:	01/08/2026

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