Provider Demographics
NPI:1053688218
Name:CINCINNATI CENTER FOR AUTISM
Entity Type:Organization
Organization Name:CINCINNATI CENTER FOR AUTISM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:D
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-874-6789
Mailing Address - Street 1:100 OFFICE PARK DRIVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014
Mailing Address - Country:US
Mailing Address - Phone:513-874-6789
Mailing Address - Fax:513-874-6787
Practice Address - Street 1:100 OFFICE PARK DRIVE
Practice Address - Street 2:SUITE H
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014
Practice Address - Country:US
Practice Address - Phone:513-874-6789
Practice Address - Fax:513-874-6787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty