Healthcare Provider Details

I. General information

NPI: 1629902739
Provider Name (Legal Business Name): RISE FOR AUTISM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 MCCORMICK DR STE U-V
GLEN BURNIE MD
21061-3283
US

IV. Provider business mailing address

510 MCCORMICK DR STE U-V
GLEN BURNIE MD
21061-3283
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 Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name: CHERYL ANTLITZ
Title or Position: EXECUTIVE/PROGRAM DIRECTOR
Credential:
Phone: 410-487-6011