Healthcare Provider Details

I. General information

NPI: 1477472413
Provider Name (Legal Business Name): SEALY AUTISM SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 MAIN ST STE 910
WORCESTER MA
01608-1723
US

IV. Provider business mailing address

370 MAIN ST STE 910
WORCESTER MA
01608-1723
US

V. Phone/Fax

Practice location:
  • Phone: 661-651-8596
  • Fax: 661-651-8596
Mailing address:
  • Phone: 661-651-8596
  • Fax: 661-651-8596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: AUGUSTUS SEALY
Title or Position: MANAGER
Credential: PHD LPCC
Phone: 661-651-8596