MEDICARE: LITTLE WARRIORS AUTISM SERVICES CORP

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1962107581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE WARRIORS AUTISM SERVICES CORP

Provider Business Mailing Address
First Line	:	8407 PINEHURST DR STE 117
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-1532
Country	:	US
Telephone Number	:	813-297-8952
Fax Number	:

Provider Business Practice Location Address
First Line	:	8407 PINEHURST DR STE 117
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-1532
Country	:	US
Telephone Number	:	813-297-8952
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELAYNE HUMPIERRE AGUERO
Credential	:
Telephone Number	:	813-297-8952

Provider Enumeration Date	:	04/03/2023
Last Update Date	:	04/03/2023

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