Provider Demographics
NPI:1417139288
Name:CENTER FOR LEARNING AND AUTISM SUPPORT SERVICES, INC.
Entity Type:Organization
Organization Name:CENTER FOR LEARNING AND AUTISM SUPPORT SERVICES, INC.
Other - Org Name:CONSULTANTS FOR LEARNING AND AUTISM SUPPORT SERVICES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SECRETARY / CTO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-286-4396
Mailing Address - Street 1:424 PENINSULA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-1653
Mailing Address - Country:US
Mailing Address - Phone:650-286-4396
Mailing Address - Fax:650-286-4397
Practice Address - Street 1:424 PENINSULA AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-1653
Practice Address - Country:US
Practice Address - Phone:650-286-4396
Practice Address - Fax:650-286-4397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 252Y00000X
CA1A-41-043252Y00000X
CA320900000X
CA21282252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
1A-41-043OtherNPA CERT