Provider Demographics
NPI:1326312885
Name:AUTISM DELAWARE
Entity Type:Organization
Organization Name:AUTISM DELAWARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN BILLER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-224-6020
Mailing Address - Street 1:924 OLD HARMONY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-4186
Mailing Address - Country:US
Mailing Address - Phone:302-224-6020
Mailing Address - Fax:302-224-6017
Practice Address - Street 1:924 OLD HARMONY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4184
Practice Address - Country:US
Practice Address - Phone:302-224-6020
Practice Address - Fax:302-224-6017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
No302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE221000204Medicaid
DE000000204Medicaid
DE222000204Medicaid