MEDICARE: CONNECTIONS FOR AUTISM

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

General Provider Information

NPI Number	:	1508518861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONNECTIONS FOR AUTISM

Provider Business Mailing Address
First Line	:	897 YORKTOWNE DR
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-8106
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	897 YORKTOWNE DR
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-8106
Country	:	US
Telephone Number	:	615-556-5477
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MYRA BENNETT
Credential	:	BCBA
Telephone Number	:	615-556-5477

Provider Enumeration Date	:	01/18/2022
Last Update Date	:	01/18/2022

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Directions to “CONNECTIONS FOR AUTISM ” Practice Location

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