Healthcare Provider Details

I. General information

NPI: 1528859535
Provider Name (Legal Business Name): MARYLAND AUTISM SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 SUMMER HILL DR
WEST FRIENDSHIP MD
21794-9538
US

IV. Provider business mailing address

2925 SUMMER HILL DR
WEST FRIENDSHIP MD
21794-9538
US

V. Phone/Fax

Practice location:
  • Phone: 202-460-2693
  • 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 Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MEGDELAWIT ESHETU GEBREMEDHIN
Title or Position: OWNER
Credential: BCBA, LBA
Phone: 202-460-2693