Healthcare Provider Details

I. General information

NPI: 1710297163
Provider Name (Legal Business Name): AUTISM BEHAVIORAL SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 WYOMING AVE
EXETER PA
18643-1918
US

IV. Provider business mailing address

1122 WYOMING AVE
EXETER PA
18643-1918
US

V. Phone/Fax

Practice location:
  • Phone: 570-655-1667
  • Fax: 570-602-4100
Mailing address:
  • Phone: 570-655-1667
  • Fax: 570-602-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS004215L
License Number StatePA

VIII. Authorized Official

Name: MRS. MARY J VESLOSKI
Title or Position: PRESIDENT
Credential: MS, BCBA
Phone: 570-655-1667