MEDICARE: AUTISM RESPOND TEAM, INC.

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	273R00000X	Psychiatric Hospital Unit	01-09-5010	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01-09-5010	OTHER	CA	PSYCHOLOGIST

General Provider Information

NPI Number	:	1871838185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUTISM RESPOND TEAM, INC.

Provider Business Mailing Address
First Line	:	16946 SHERMAN WAY
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91406-3613
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16946 SHERMAN WAY
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91406-3613
Country	:	US
Telephone Number	:	818-401-0661
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	ALI SADEGHI
Credential	:
Telephone Number	:	818-401-0661

Provider Enumeration Date	:	11/28/2012
Last Update Date	:	11/28/2012

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