Provider Demographics
NPI:1184386120
Name:AUTISM SPARKLES LLC
Entity type:Organization
Organization Name:AUTISM SPARKLES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BCBA
Authorized Official - Prefix:
Authorized Official - First Name:ALYSE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ENDERLE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA/LBA
Authorized Official - Phone:860-462-7322
Mailing Address - Street 1:19 S GEORGE WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4541
Mailing Address - Country:US
Mailing Address - Phone:860-462-7322
Mailing Address - Fax:
Practice Address - Street 1:19 S GEORGE WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4541
Practice Address - Country:US
Practice Address - Phone:860-462-7322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty