=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154759280
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GALENA AUTISM AND BEHAVIORAL SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2013
-----------------------------------------------------
Last Update Date | 10/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24 CREEK RD
-----------------------------------------------------
City | CHALFONT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18914-1523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-353-0764
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 CREEK RD
-----------------------------------------------------
City | CHALFONT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18914-1523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-353-0764
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO, BEHAVIOR CONSULTANT
-----------------------------------------------------
Name | MRS. NAA AMELEY GARRIDO
-----------------------------------------------------
Credential | MS, BCBA, BSL
-----------------------------------------------------
Telephone | 215-353-0764
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | BH000658
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------