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NPI Code Detail

MEDICARE: SPECTRUM AUTISM SERVICES, LLC

MEDICARE: SPECTRUM 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
1251S00000XCommunity/Behavioral Health Agency
2103K00000XBehavior Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184149403
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPECTRUM AUTISM SERVICES, LLC
Provider Business Mailing Address
First Line : 12 MONUMENT DR
Second Line :
City : STAFFORD
State : VA
Zip : 22554-8508
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 35 WALPOLE ST STE 207
Second Line :
City : STAFFORD
State : VA
Zip : 22554-6546
Country : US
Telephone Number : 540-383-7133
Fax Number :
Authorized Official
Title or Position : CEO
Name : NANCY DALY
Credential : M.A., BCBA, LBA
Telephone Number : 540-383-7133
Provider Enumeration Date : 08/08/2017
Last Update Date : 05/14/2025

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Directions to “SPECTRUM AUTISM SERVICES, LLC ” Practice Location

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