MEDICARE: AUTISM AND EDUCATION 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1336955517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUTISM AND EDUCATION LLC

Provider Business Mailing Address
First Line	:	4856 VILLAGE GREEN WAY
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92407-2923
Country	:	US
Telephone Number	:	909-965-1077
Fax Number	:

Provider Business Practice Location Address
First Line	:	4856 VILLAGE GREEN WAY
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92407-2923
Country	:	US
Telephone Number	:	909-965-1077
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOSEPH PALMEIRA
Credential	:	BCBA
Telephone Number	:	909-965-1077

Provider Enumeration Date	:	12/03/2024
Last Update Date	:	12/03/2024

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