Provider Demographics
NPI:1760700033
Name:INNOVATIVE AUTISM SERVICES
Entity Type:Organization
Organization Name:INNOVATIVE AUTISM SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCELA
Authorized Official - Middle Name:O
Authorized Official - Last Name:NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:860-351-5407
Mailing Address - Street 1:56 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-1904
Mailing Address - Country:US
Mailing Address - Phone:860-351-5407
Mailing Address - Fax:860-351-5774
Practice Address - Street 1:56 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-1904
Practice Address - Country:US
Practice Address - Phone:860-351-5407
Practice Address - Fax:860-351-5774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-03-1386103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty