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General NPI Number Information
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NPI Number | 1578963120
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Entity Type | Organization
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Legal Business Name | AUTISM SOLUTIONS OF TAMPA BAY LLC
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Dates
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Enumeration Date | 09/02/2014
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Last Update Date | 05/23/2016
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Provider Practice Location Address
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Address Line | 2905 MOSSY TIMBER TRL
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City | VALRICO
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State | FL
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Zip | 33596-7949
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Country | US
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Telephone | 813-643-9669
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Fax |
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Provider Business Mailing Address
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Address Line | 2905 MOSSY TIMBER TRL
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City | VALRICO
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State | FL
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Zip | 33596-7949
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Country | US
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Telephone | 813-643-9669
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. ANTHONY R PAWLISZ
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Credential | MBA
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Telephone | 813-643-9669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | L14000134355
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | L14000134355
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License Number State | FL
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