Provider Demographics
NPI:1275921587
Name:AUTISM CENTER OF NORTHERN CALIFORNIA
Entity Type:Organization
Organization Name:AUTISM CENTER OF NORTHERN CALIFORNIA
Other - Org Name:JUMPSTART LEARNING TO LEARN
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF THE ACNC
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:415-391-3417
Mailing Address - Street 1:870 MARKET ST
Mailing Address - Street 2:SUITE 474
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-3099
Mailing Address - Country:US
Mailing Address - Phone:415-391-3417
Mailing Address - Fax:866-656-5932
Practice Address - Street 1:870 MARKET ST
Practice Address - Street 2:SUITE 474
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-3099
Practice Address - Country:US
Practice Address - Phone:415-391-3417
Practice Address - Fax:866-656-5932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2879023261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities