MEDICARE: GAEA 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	174400000X	Specialist

General Provider Information

NPI Number	:	1972925212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GAEA AUTISM INC.

Provider Business Mailing Address
First Line	:	226 WHEELER AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-5112
Country	:	US
Telephone Number	:	646-372-7073
Fax Number	:

Provider Business Practice Location Address
First Line	:	226 WHEELER AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-5112
Country	:	US
Telephone Number	:	646-372-7073
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	RACHEL ANNE LUNDEN-CARTER
Credential	:	MS SPED
Telephone Number	:	646-372-7073

Provider Enumeration Date	:	01/06/2014
Last Update Date	:	01/14/2014

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Directions to “GAEA AUTISM INC. ” Practice Location

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