Healthcare Provider Details

I. General information

NPI: 1376154690
Provider Name (Legal Business Name): ASCEND AUTISM BEHAVIORAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 N REGENT ST
PORT CHESTER NY
10573-2642
US

IV. Provider business mailing address

243 N REGENT ST
PORT CHESTER NY
10573-2642
US

V. Phone/Fax

Practice location:
  • Phone: 617-233-9907
  • Fax:
Mailing address:
  • Phone: 617-233-9907
  • 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 Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: NATHAN KRONFORST
Title or Position: VICE PRESIDENT
Credential:
Phone: 617-233-9907