Provider Demographics
NPI:1629362538
Name:KINNEY CENTER FOR AUTISM EDUCATION AND SUPPORT
Entity Type:Organization
Organization Name:KINNEY CENTER FOR AUTISM EDUCATION AND SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:610-660-2170
Mailing Address - Street 1:5600 CITY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-1308
Mailing Address - Country:US
Mailing Address - Phone:610-660-2170
Mailing Address - Fax:610-660-2175
Practice Address - Street 1:5600 CITY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1308
Practice Address - Country:US
Practice Address - Phone:610-660-2170
Practice Address - Fax:610-660-2175
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT JOSEPH'S UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1063173103K00000X
PAOP102029103K00000X
PAPS007950L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty