Provider Demographics
NPI:1023432218
Name:STEPPING STONES CENTER FOR AUTISTIC SPECTRUM DISORDERS, INC,
Entity type:Organization
Organization Name:STEPPING STONES CENTER FOR AUTISTIC SPECTRUM DISORDERS, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-357-0571
Mailing Address - Street 1:3190 CLEARVIEW WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3752
Mailing Address - Country:US
Mailing Address - Phone:650-357-0571
Mailing Address - Fax:650-357-0676
Practice Address - Street 1:3190 CLEARVIEW WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3752
Practice Address - Country:US
Practice Address - Phone:650-357-0571
Practice Address - Fax:650-357-0676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11314230103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11314230OtherBOARD CERTIFIED BEHAVIOR ANALYST