Healthcare Provider Details

I. General information

NPI: 1326312885
Provider Name (Legal Business Name): AUTISM DELAWARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 OLD HARMONY RD SUITE 201
NEWARK DE
19713-4184
US

IV. Provider business mailing address

924 OLD HARMONY RD SUITE 201
NEWARK DE
19713-4186
US

V. Phone/Fax

Practice location:
  • Phone: 302-224-6020
  • Fax: 302-224-6017
Mailing address:
  • Phone: 302-224-6020
  • Fax: 302-224-6017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name: KIM ROSEBAUM
Title or Position: ADMIN BILLER
Credential:
Phone: 302-224-6020