Provider Demographics
NPI:1881205110
Name:THE AUTISM IMPACT CIRCLE
Entity Type:Organization
Organization Name:THE AUTISM IMPACT CIRCLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA, LLC OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHWAY
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, BCBA
Authorized Official - Phone:831-331-8529
Mailing Address - Street 1:201 13TH ST # 32491
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3921
Mailing Address - Country:US
Mailing Address - Phone:510-969-7844
Mailing Address - Fax:
Practice Address - Street 1:9015 SAGE RD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-4603
Practice Address - Country:US
Practice Address - Phone:831-331-8529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty