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General NPI Number Information
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NPI Number | 1033541438
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Entity Type | Organization
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Legal Business Name | AUTISM DIAGNOSTIC EVALUATIONS RESOURCES SERVICES
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Dates
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Enumeration Date | 08/07/2013
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 276 GRAYLYN CREST DR
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City | NEW COLUMBIA
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State | PA
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Zip | 17856
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Country | US
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Telephone | 570-204-3717
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Fax |
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Provider Business Mailing Address
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Address Line | 276 GRAYLYN CREST DR
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City | NEW COLUMBIA
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State | PA
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Zip | 17856-9418
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Country | US
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Telephone | 570-204-3717
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Fax |
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Authorized Official
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Title or Position | BEHAVIOR SPECIALIST
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Name | MR. STEVE JAMES MCANNANEY
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Credential | MSW
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Telephone | 570-204-3717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1052542
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License Number State | PA
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