| Pennsylvania Autism Action Center Llc | |
|
2071 Route 209 Brodheadsville PA 18322-7754 | |
| (570) 992-6720 | |
| (570) 992-6736 |
| Full Name | Pennsylvania Autism Action Center Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 2071 Route 209, Brodheadsville, Pennsylvania |
| Authorized Official Name and Position | Michelle Meaeny Demarsh (PRINCIPAL OWNER) |
| Authorized Official Contact | 5709926720 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pennsylvania Autism Action Center Llc 2071 Route 209 Brodheadsville PA 18322-7754 Ph: (570) 992-6720 | Pennsylvania Autism Action Center Llc 2071 Route 209 Brodheadsville PA 18322-7754 Ph: (570) 992-6720 |
| NPI Number | 1568809275 |
|---|---|
| Provider Enumeration Date | 06/04/2013 |
| Last Update Date | 03/09/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568809275 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 1-03-1139 (Pennsylvania) | Primary |
| 225XP0200X | Occupational Therapist - Pediatrics | (* (Not Available)) | Secondary |
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