Provider Demographics
NPI:1902366404
Name:PENNSYLVANIA AUTISM SERVICES
Entity Type:Organization
Organization Name:PENNSYLVANIA AUTISM SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:FAJR
Authorized Official - Middle Name:KHALIFAH
Authorized Official - Last Name:ELHADI
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:484-590-5209
Mailing Address - Street 1:201 KING OF PRUSSIA RD STE 650
Mailing Address - Street 2:
Mailing Address - City:RADNOR
Mailing Address - State:PA
Mailing Address - Zip Code:19087-5156
Mailing Address - Country:US
Mailing Address - Phone:484-590-5209
Mailing Address - Fax:
Practice Address - Street 1:201 KING OF PRUSSIA RD STE 650
Practice Address - Street 2:
Practice Address - City:RADNOR
Practice Address - State:PA
Practice Address - Zip Code:19087-5156
Practice Address - Country:US
Practice Address - Phone:484-590-5209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-21
Last Update Date:2021-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health