Healthcare Provider Details

I. General information

NPI: 1982116588
Provider Name (Legal Business Name): RISE FOR AUTISM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2017
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 MCCORMICK DR STE U
GLEN BURNIE MD
21061-8283
US

IV. Provider business mailing address

510 MCCORMICK DR STE U
GLEN BURNIE MD
21061-8283
US

V. Phone/Fax

Practice location:
  • Phone: 410-487-6011
  • Fax:
Mailing address:
  • Phone: 410-487-6011
  • 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 Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: CHERYL ANN ANTLITZ
Title or Position: EXECUTIVE DIRECTOR
Credential: RN
Phone: 410-487-6011