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General NPI Number Information
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NPI Number | 1073984340
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Entity Type | Organization
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Legal Business Name | ANDERSON CENTER FOR AUTISM
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Dates
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Enumeration Date | 10/13/2015
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Last Update Date | 10/13/2015
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Provider Practice Location Address
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Address Line | 4885 ROUTE 9
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City | STAATSBURG
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State | NY
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Zip | 12580-6028
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Country | US
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Telephone | 845-889-9507
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 367
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City | STAATSBURG
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State | NY
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Zip | 12580-0367
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | ALYSSA CENTONZE
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Credential | MS, CCC-SLP
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Telephone | 845-889-9507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 025175
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License Number State | NY
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