Healthcare Provider Details

I. General information

NPI: 1336522515
Provider Name (Legal Business Name): ELS FOR AUTISM FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18370 LIMESTONE CREEK RD
JUPITER FL
33458-3860
US

IV. Provider business mailing address

18370 LIMESTONE CREEK RD
JUPITER FL
33458-3860
US

V. Phone/Fax

Practice location:
  • Phone: 561-625-8269
  • Fax: 561-320-9495
Mailing address:
  • Phone: 561-625-8269
  • Fax: 561-320-9495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number03991
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number14230
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA6361
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberNH 8400
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB1-11-8447
License Number StateFL

VIII. Authorized Official

Name: DR. MARLENE SOTELO
Title or Position: PROGRAM DIRECTOR
Credential: BCBA-D, MT-BC
Phone: 561-625-8269