MEDICARE: LACUNA AUTISM SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1013736107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LACUNA AUTISM SERVICES LLC

Provider Business Mailing Address
First Line	:	830 TENDERFOOT HILL RD STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-7372
Country	:	US
Telephone Number	:	888-611-0870
Fax Number	:	888-714-4996

Provider Business Practice Location Address
First Line	:	139 ORANGE ST
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06510-3140
Country	:	US
Telephone Number	:	888-611-0870
Fax Number	:	888-714-4996

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSEPH CREAGER
Credential	:
Telephone Number	:	888-611-0870

Provider Enumeration Date	:	10/07/2024
Last Update Date	:	10/07/2024

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Directions to “LACUNA AUTISM SERVICES LLC ” Practice Location

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