Provider Demographics
NPI:1831496280
Name:AUTISM SERVICES GROUP
Entity Type:Organization
Organization Name:AUTISM SERVICES GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGEMENT DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUSSOM
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:609-454-4598
Mailing Address - Street 1:200 PRINCETON SOUTH CORPORATE CENTER
Mailing Address - Street 2:SUITE 260
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-3435
Mailing Address - Country:US
Mailing Address - Phone:609-454-4598
Mailing Address - Fax:609-454-4599
Practice Address - Street 1:200 PRINCETON SOUTH CORPORATE CTR
Practice Address - Street 2:SUITE 260
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-3434
Practice Address - Country:US
Practice Address - Phone:609-454-4598
Practice Address - Fax:609-454-4599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty