Healthcare Provider Details

I. General information

NPI: 1790223675
Provider Name (Legal Business Name): EARLY DAYS AUTISM CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2017
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9470 MICRON AVE
SACRAMENTO CA
95827-2612
US

IV. Provider business mailing address

9500 MICRON AVE STE 132
SACRAMENTO CA
95827-2619
US

V. Phone/Fax

Practice location:
  • Phone: 916-947-6255
  • Fax:
Mailing address:
  • Phone: 916-947-6255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY19810
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number92506
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11416148
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11211648
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11152078
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. CYNTHIA ZIERHUT
Title or Position: OWNER/CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 916-947-6255