Provider Demographics
NPI:1376158055
Name:COMPASSIONATE THERAPY FOR AUTISM, LLC
Entity Type:Organization
Organization Name:COMPASSIONATE THERAPY FOR AUTISM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LBA
Authorized Official - Prefix:
Authorized Official - First Name:ROXANA
Authorized Official - Middle Name:I
Authorized Official - Last Name:NEDELCU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LBA BCBA
Authorized Official - Phone:347-707-6610
Mailing Address - Street 1:1315 SE UMATILLA ST APT 203
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-7175
Mailing Address - Country:US
Mailing Address - Phone:347-707-6610
Mailing Address - Fax:
Practice Address - Street 1:6124 SE MILWAUKIE AVE STE 205203
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-5347
Practice Address - Country:US
Practice Address - Phone:347-707-6610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty