| Petalu'da Autism Services Llc | |
|
6 Elizabeth Ln Vernon CT 06066-5056 | |
| (860) 983-8112 | |
| Not Available |
| Full Name | Petalu'da Autism Services Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 6 Elizabeth Ln, Vernon, Connecticut |
| Authorized Official Name and Position | Keisha Powell (AUTISM THERAPIST) |
| Authorized Official Contact | 8609838112 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Petalu'da Autism Services Llc 6 Elizabeth Ln Vernon CT 06066-5056 Ph: (860) 983-8112 | Petalu'da Autism Services Llc 6 Elizabeth Ln Vernon CT 06066-5056 Ph: (860) 983-8112 |
| NPI Number | 1245578475 |
|---|---|
| Provider Enumeration Date | 01/23/2013 |
| Last Update Date | 11/08/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245578475 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 11211741 (Connecticut) | Primary |
| 305S00000X | Point Of Service | 3928518916 (Connecticut) | Secondary |
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