Provider Demographics
NPI:1770225609
Name:AUTISM CENTER COMMITTED TO EDUCATE SCIENTIFICALLY
Entity Type:Organization
Organization Name:AUTISM CENTER COMMITTED TO EDUCATE SCIENTIFICALLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA
Authorized Official - Phone:909-366-9344
Mailing Address - Street 1:1638 WINDSOR ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-3364
Mailing Address - Country:US
Mailing Address - Phone:909-366-9344
Mailing Address - Fax:909-235-4762
Practice Address - Street 1:930 S MOUNT VERNON AVE STE 900
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3976
Practice Address - Country:US
Practice Address - Phone:909-366-9344
Practice Address - Fax:909-235-4762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty