Provider Demographics
NPI:1356686042
Name:QUALITY SERVICES FOR THE AUTISM COMMUNITY
Entity Type:Organization
Organization Name:QUALITY SERVICES FOR THE AUTISM COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUMOULIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:718-728-8476
Mailing Address - Street 1:253 W 35TH ST
Mailing Address - Street 2:16TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-1907
Mailing Address - Country:US
Mailing Address - Phone:718-728-8476
Mailing Address - Fax:718-229-7539
Practice Address - Street 1:24537 60TH AVE
Practice Address - Street 2:
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11362-2014
Practice Address - Country:US
Practice Address - Phone:718-728-8476
Practice Address - Fax:718-229-7359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031992-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency