=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922463736
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UBUNTU AUTISM CONSULTANTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2015
-----------------------------------------------------
Last Update Date | 02/18/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 225 CEDAR HILL ST STE 200
-----------------------------------------------------
City | MARLBOROUGH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01752-5900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-202-0506
-----------------------------------------------------
Fax | 508-519-5351
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 225 CEDAR HILL ST STE 200
-----------------------------------------------------
City | MARLBOROUGH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01752-5900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-202-0506
-----------------------------------------------------
Fax | 508-519-5351
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-FOUNDER
-----------------------------------------------------
Name | GRACE GITAU
-----------------------------------------------------
Credential | BBA
-----------------------------------------------------
Telephone | 774-312-1810
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 1-14-9986
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------