Provider Demographics
NPI:1417705203
Name:ADVANCED AUTISM SERVICES MD LLC
Entity type:Organization
Organization Name:ADVANCED AUTISM SERVICES MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADVANCED AUTISM
Authorized Official - Middle Name:
Authorized Official - Last Name:SERVICES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-777-9158
Mailing Address - Street 1:PO BOX 1335
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-1011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6701 DEMOCRACY BLVD STE 300
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-7500
Practice Address - Country:US
Practice Address - Phone:410-777-9158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty