Provider Demographics
NPI:1083036065
Name:CINCINNATI CENTER FOR AUTISM
Entity Type:Organization
Organization Name:CINCINNATI CENTER FOR AUTISM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DEVELOPMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BETSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-874-6789
Mailing Address - Street 1:305 CAMERON RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:OH
Mailing Address - Zip Code:45246-4101
Mailing Address - Country:US
Mailing Address - Phone:513-874-6789
Mailing Address - Fax:
Practice Address - Street 1:305 CAMERON RD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:OH
Practice Address - Zip Code:45246-4101
Practice Address - Country:US
Practice Address - Phone:513-874-6789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty