| The Autism Spark LLC | |
|
30 Stefaniak Ave Webster MA 01570-2032 | |
| (774) 232-4597 | |
| Not Available |
| Full Name | The Autism Spark LLC |
|---|---|
| Speciality | Behavior Analyst |
| Location | 30 Stefaniak Ave, Webster, Massachusetts |
| Authorized Official Name and Position | Cynthia Azu (CO-CHIEF EXECUTIVE OFFICER(CO-CEO)) |
| Authorized Official Contact | 7742324597 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Autism Spark LLC 30 Stefaniak Ave Webster MA 01570-2032 Ph: (774) 232-4597 | The Autism Spark LLC 30 Stefaniak Ave Webster MA 01570-2032 Ph: (774) 232-4597 |
| NPI Number | 1053888164 |
|---|---|
| Provider Enumeration Date | 10/26/2018 |
| Last Update Date | 10/26/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053888164 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (NU) | Primary |
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