Provider Demographics
NPI:1598037160
Name:ACUMENTAL LLC
Entity Type:Organization
Organization Name:ACUMENTAL LLC
Other - Org Name:AUTISM FAMILY SUPPORT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BEHAVIORAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HOOTS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:410-808-6561
Mailing Address - Street 1:25 PRIMROSE CT
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-3366
Mailing Address - Country:US
Mailing Address - Phone:410-808-6561
Mailing Address - Fax:410-869-2293
Practice Address - Street 1:25 PRIMROSE CT
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-3366
Practice Address - Country:US
Practice Address - Phone:410-808-6561
Practice Address - Fax:410-869-2293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1-09-6427103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty