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General NPI Number Information
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NPI Number | 1710297163
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Entity Type | Organization
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Legal Business Name | AUTISM BEHAVIORAL SERVICES, INC
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Dates
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Enumeration Date | 10/19/2010
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Last Update Date | 10/19/2010
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Provider Practice Location Address
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Address Line | 1122 WYOMING AVE
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City | EXETER
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State | PA
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Zip | 18643-1918
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Country | US
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Telephone | 570-655-1667
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Fax | 570-602-4100
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Provider Business Mailing Address
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Address Line | 1122 WYOMING AVE
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City | EXETER
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State | PA
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Zip | 18643-1918
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Country | US
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Telephone | 570-655-1667
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Fax | 570-602-4100
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MARY J VESLOSKI
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Credential | MS, BCBA
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Telephone | 570-655-1667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PS004215L
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License Number State | PA
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