Provider Demographics
NPI:1659012243
Name:ADVANCED AUTISM SERVICES MA LLC
Entity Type:Organization
Organization Name:ADVANCED AUTISM SERVICES MA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:MALKA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERSKO
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:602-584-9860
Mailing Address - Street 1:36 AIRPORT RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-7034
Mailing Address - Country:US
Mailing Address - Phone:602-584-9860
Mailing Address - Fax:602-715-1135
Practice Address - Street 1:240 ELM ST FL 2
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2935
Practice Address - Country:US
Practice Address - Phone:602-584-9860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty