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General NPI Number Information
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NPI Number | 1902046725
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Entity Type | Organization
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Legal Business Name | THE RICH CENTER FOR AUTISM @YSU
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Dates
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Enumeration Date | 03/06/2009
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Last Update Date | 03/06/2009
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Provider Practice Location Address
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Address Line | ONE UNIVERSITY PLAZA
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City | YOUNGSTOWN
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State | OH
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Zip | 44555
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Country | US
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Telephone | 330-941-1927
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Fax | 330-941-4670
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Provider Business Mailing Address
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Address Line | ONE UNIVERSITY PLAZA
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City | YOUNGSTOWN
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State | OH
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Zip | 44555
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Country | US
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Telephone | 330-941-1927
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Fax | 330-941-4670
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. J. GEORGIA BACKUS
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Credential |
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Telephone | 330-941-4669
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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 | 294860851
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License Number State | OH
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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 | OT-05585
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License Number State | OH
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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 | SP8310
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License Number State |
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