Healthcare Provider Details

I. General information

NPI: 1417705203
Provider Name (Legal Business Name): ADVANCED AUTISM SERVICES MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 DEMOCRACY BLVD STE 300
BETHESDA MD
20817-7500
US

IV. Provider business mailing address

PO BOX 1335
LAKEWOOD NJ
08701-1011
US

V. Phone/Fax

Practice location:
  • Phone: 410-777-9158
  • Fax:
Mailing address:
  • Phone:
  • 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: ADVANCED AUTISM SERVICES
Title or Position: OWNER
Credential:
Phone: 410-777-9158