Provider Demographics
NPI:1225260466
Name:NORTHEAST AUTISM CENTER INC.
Entity Type:Organization
Organization Name:NORTHEAST AUTISM CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUSHWICK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:570-575-2378
Mailing Address - Street 1:1401 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-2224
Mailing Address - Country:US
Mailing Address - Phone:570-558-3198
Mailing Address - Fax:
Practice Address - Street 1:1401 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-2224
Practice Address - Country:US
Practice Address - Phone:570-558-3198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health