Provider Demographics
NPI:1578963120
Name:AUTISM SOLUTIONS OF TAMPA BAY LLC
Entity Type:Organization
Organization Name:AUTISM SOLUTIONS OF TAMPA BAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:R
Authorized Official - Last Name:PAWLISZ
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:813-643-9669
Mailing Address - Street 1:2905 MOSSY TIMBER TRL
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-7949
Mailing Address - Country:US
Mailing Address - Phone:813-643-9669
Mailing Address - Fax:
Practice Address - Street 1:2905 MOSSY TIMBER TRL
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-7949
Practice Address - Country:US
Practice Address - Phone:813-643-9669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-02
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL14000134355103K00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016104300Medicaid