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General NPI Number Information
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NPI Number | 1164058921
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH AUTISM SERVICES LLC
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Dates
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Enumeration Date | 03/12/2020
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Last Update Date | 03/12/2020
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Provider Practice Location Address
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Address Line | 95 PLEASANT ST
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City | GRAFTON
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State | MA
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Zip | 01519-1031
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Country | US
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Telephone | 617-759-9302
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1736
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City | PLAINVILLE
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State | MA
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Zip | 02762-0736
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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 | SIGNATORY
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Name | ROBERT POLSINELLI
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Credential |
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Telephone | 617-759-9302
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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 |
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License Number State |
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