Provider Demographics
NPI:1427606011
Name:AUTISM DIAGNOSTIC EVALUATIONS RESOURCES SERVICES
Entity Type:Organization
Organization Name:AUTISM DIAGNOSTIC EVALUATIONS RESOURCES SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MCANNANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-523-6787
Mailing Address - Street 1:276 GRAYLYN CREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW COLUMBIA
Mailing Address - State:PA
Mailing Address - Zip Code:17856
Mailing Address - Country:US
Mailing Address - Phone:570-523-6787
Mailing Address - Fax:
Practice Address - Street 1:900 BUFFALO RD STE 1
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-1206
Practice Address - Country:US
Practice Address - Phone:570-523-6787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty