Provider Demographics
NPI:1306582887
Name:AUTISM ALLY GROUP
Entity type:Organization
Organization Name:AUTISM ALLY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SCHERAZADE
Authorized Official - Middle Name:
Authorized Official - Last Name:AGURTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-857-1101
Mailing Address - Street 1:9500 ANNAPOLIS RD STE C3
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2074
Mailing Address - Country:US
Mailing Address - Phone:301-857-1101
Mailing Address - Fax:
Practice Address - Street 1:9500 ANNAPOLIS RD STE C3
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2074
Practice Address - Country:US
Practice Address - Phone:301-857-1101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services