Provider Demographics
NPI:1033541438
Name:AUTISM DIAGNOSTIC EVALUATIONS RESOURCES SERVICES
Entity Type:Organization
Organization Name:AUTISM DIAGNOSTIC EVALUATIONS RESOURCES SERVICES
Other - Org Name:ADERS
Other - Org Type:Other Name
Authorized Official - Title/Position:BEHAVIOR SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MCANNANEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:570-204-3717
Mailing Address - Street 1:276 GRAYLYN CREST DR
Mailing Address - Street 2:
Mailing Address - City:NEW COLUMBIA
Mailing Address - State:PA
Mailing Address - Zip Code:17856-9418
Mailing Address - Country:US
Mailing Address - Phone:570-204-3717
Mailing Address - Fax:
Practice Address - Street 1:276 GRAYLYN CREST DR
Practice Address - Street 2:
Practice Address - City:NEW COLUMBIA
Practice Address - State:PA
Practice Address - Zip Code:17856
Practice Address - Country:US
Practice Address - Phone:570-204-3717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-07
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1052542251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102523480OtherMASTER PROVIDER INDEX (MPI)
PA1-052-542OtherBCBA
PA032542302OtherDUNS