MEDICARE: THE ONE WORLD CENTER FOR AUTISM, INC.

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1063927606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ONE WORLD CENTER FOR AUTISM, INC.

Provider Business Mailing Address
First Line	:	7401 FORBES BLVD STE A
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-2288
Country	:	US
Telephone Number	:	301-618-8395
Fax Number	:

Provider Business Practice Location Address
First Line	:	7401 FORBES BLVD STE A
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-2288
Country	:	US
Telephone Number	:	130-161-8839
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE/ MEDICAL DIRECTOR
Name	:	DR. ABILA VIOLET TAZANU
Credential	:	M.D.
Telephone Number	:	301-618-8395

Provider Enumeration Date	:	12/05/2017
Last Update Date	:	12/05/2017

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