=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932415056
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTER FOR AUTISM SPECTRUM TREATMENT, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2010
-----------------------------------------------------
Last Update Date | 08/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11940 SAN VICENTE BLVD STE 255
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90049-5004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-985-0372
-----------------------------------------------------
Fax | 310-943-6813
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 311 N ROBERTSON BLVD STE 421
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90211-1705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-985-0372
-----------------------------------------------------
Fax | 310-943-6813
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | MRS. EFTHYMIA MARIA PYLADAKI
-----------------------------------------------------
Credential | MS, BCBA
-----------------------------------------------------
Telephone | 310-985-0372
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | BACB1095670
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------