Provider Demographics
NPI:1609320936
Name:PENNSYLVANIA AUTISM ACTION CENTER
Entity Type:Organization
Organization Name:PENNSYLVANIA AUTISM ACTION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMARSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-992-6720
Mailing Address - Street 1:2071 ROUTE 209
Mailing Address - Street 2:
Mailing Address - City:TOBYHANNA
Mailing Address - State:PA
Mailing Address - Zip Code:18466
Mailing Address - Country:US
Mailing Address - Phone:570-992-6720
Mailing Address - Fax:570-992-6736
Practice Address - Street 1:2071 ROUTE 209
Practice Address - Street 2:
Practice Address - City:TOBYHANNA
Practice Address - State:PA
Practice Address - Zip Code:18322
Practice Address - Country:US
Practice Address - Phone:570-992-6720
Practice Address - Fax:570-992-6736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-16-22395103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty