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General NPI Number Information
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NPI Number | 1336522515
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Entity Type | Organization
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Legal Business Name | ELS FOR AUTISM FOUNDATION
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 06/23/2016
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Provider Practice Location Address
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Address Line | 18370 LIMESTONE CREEK RD
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City | JUPITER
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State | FL
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Zip | 33458-3860
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Country | US
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Telephone | 561-625-8269
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Fax | 561-320-9495
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Provider Business Mailing Address
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Address Line | 18370 LIMESTONE CREEK RD
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City | JUPITER
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State | FL
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Zip | 33458-3860
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Country | US
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Telephone | 561-625-8269
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Fax | 561-320-9495
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | DR. MARLENE SOTELO
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Credential | BCBA-D, MT-BC
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Telephone | 561-625-8269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225A00000X
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Taxonomy Name | Music Therapist
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License Number | 03991
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 14230
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA6361
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | NH 8400
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BACB1-11-8447
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License Number State | FL
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