Healthcare Provider Details

I. General information

NPI: 1346848314
Provider Name (Legal Business Name): PREMIER AUTISM SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 S 4TH ST STE 700
LOUISVILLE KY
40202-3046
US

IV. Provider business mailing address

211 BOULEVARD OF AMERICAS STE 402
LAKEWOOD NJ
08701-4778
US

V. Phone/Fax

Practice location:
  • Phone: 502-305-5730
  • Fax: 502-305-5740
Mailing address:
  • Phone: 502-305-5730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: JASON HERSKO
Title or Position: OWNER
Credential: MS
Phone: 502-305-5730