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General NPI Number Information
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NPI Number | 1538898440
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Entity Type | Organization
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Legal Business Name | ADVANCED AUTISM SERVICES IN LLC
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Dates
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Enumeration Date | 06/07/2022
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Last Update Date | 06/07/2022
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Provider Practice Location Address
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Address Line | 3815 RIVER CROSSING PKWY STE 100
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-7766
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Country | US
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Telephone | 602-584-9860
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Fax |
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Provider Business Mailing Address
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Address Line | 36 AIRPORT RD STE 105
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City | LAKEWOOD
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State | NJ
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Zip | 08701-7034
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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 | DIRECTOR
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Name | MALKA HERSKO
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Credential | MS CCC SLP
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Telephone | 602-584-9860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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