MEDICARE: CENTER FOR AUTISM SPECTRUM TREATMENT, 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	251S00000X	Community/Behavioral Health Agency	BACB1095670	CA

General Provider Information

NPI Number	:	1932415056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR AUTISM SPECTRUM TREATMENT, INC

Provider Business Mailing Address
First Line	:	311 N ROBERTSON BLVD STE 421
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-1705
Country	:	US
Telephone Number	:	310-985-0372
Fax Number	:	310-943-6813

Provider Business Practice Location Address
First Line	:	11940 SAN VICENTE BLVD STE 255
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-5004
Country	:	US
Telephone Number	:	310-985-0372
Fax Number	:	310-943-6813

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MRS. EFTHYMIA MARIA PYLADAKI
Credential	:	MS, BCBA
Telephone Number	:	310-985-0372

Provider Enumeration Date	:	08/26/2010
Last Update Date	:	08/26/2010

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