Healthcare Provider Details

I. General information

NPI: 1275132458
Provider Name (Legal Business Name): AUTISM BEHAVIORAL & THERAPEUTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 BEDFORD AVE
WORCESTER MA
01604-4707
US

IV. Provider business mailing address

5 BEDFORD AVE
WORCESTER MA
01604-4707
US

V. Phone/Fax

Practice location:
  • Phone: 774-232-4975
  • Fax:
Mailing address:
  • Phone: 774-232-4975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ELIZABETH CIERA
Title or Position: RN BSN
Credential:
Phone: 774-232-4975