Healthcare Provider Details

I. General information

NPI: 1336409473
Provider Name (Legal Business Name): AUTISM SPECTRUM MANDATE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 NAPLES LN
MOUNT LAUREL NJ
08054-9645
US

IV. Provider business mailing address

16 NAPLES LN
MOUNT LAUREL NJ
08054-9645
US

V. Phone/Fax

Practice location:
  • Phone: 609-953-5793
  • Fax:
Mailing address:
  • Phone: 609-953-5793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1084410
License Number StateFL

VIII. Authorized Official

Name: MS. REBECCA KHETTRY-CLAY
Title or Position: FOUNDER
Credential: M.A.,B.C.B.A.
Phone: 609-953-5793