Healthcare Provider Details

I. General information

NPI: 1043554975
Provider Name (Legal Business Name): PALM BEACH SCHOOL FOR AUTISM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 03/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8480 LANTANA RD
LAKE WORTH FL
33467
US

IV. Provider business mailing address

8480 LANTANA RD
LAKE WORTH FL
33467
US

V. Phone/Fax

Practice location:
  • Phone: 561-533-9917
  • Fax: 561-533-9918
Mailing address:
  • Phone: 561-533-9917
  • Fax: 561-533-9918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANN LEVENE-EISENBERG
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 561-533-9917