Provider Demographics
NPI:1700679800
Name:SOUTHEASTERN AUTISM CENTER LLC
Entity type:Organization
Organization Name:SOUTHEASTERN AUTISM CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA
Authorized Official - Phone:315-569-1112
Mailing Address - Street 1:3884 BANNOCK AVE
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-9201
Mailing Address - Country:US
Mailing Address - Phone:315-569-1112
Mailing Address - Fax:
Practice Address - Street 1:3884 BANNOCK AVE
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-9201
Practice Address - Country:US
Practice Address - Phone:315-569-1112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty