Healthcare Provider Details

I. General information

NPI: 1124562228
Provider Name (Legal Business Name): TLC AUTISM SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 S SEMORAN BLVD SUITE B
ORLANDO FL
32807-3262
US

IV. Provider business mailing address

36 S SEMORAN BLVD SUITE B
ORLANDO FL
32807-3262
US

V. Phone/Fax

Practice location:
  • Phone: 407-601-7631
  • Fax: 407-286-7494
Mailing address:
  • Phone: 407-601-7631
  • Fax: 407-286-7494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY7320
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: ROSA M ROSARIO
Title or Position: OWNER/DIRECTOR OF OPERATIONS
Credential:
Phone: 407-601-7631