Provider Demographics
NPI:1730503400
Name:AUTISM THERAPISTS AND CONSULTANTS
Entity type:Organization
Organization Name:AUTISM THERAPISTS AND CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEGGAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GHISHIJOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-885-5044
Mailing Address - Street 1:158 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:MA
Mailing Address - Zip Code:01562-2260
Mailing Address - Country:US
Mailing Address - Phone:508-885-5044
Mailing Address - Fax:
Practice Address - Street 1:158 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:MA
Practice Address - Zip Code:01562-2260
Practice Address - Country:US
Practice Address - Phone:508-885-5044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty