Provider Demographics
NPI:1205341286
Name:AUTISM SPECIFIC CONSULTING PLLC
Entity type:Organization
Organization Name:AUTISM SPECIFIC CONSULTING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MATSKO
Authorized Official - Suffix:JR
Authorized Official - Credentials:BSL
Authorized Official - Phone:570-354-2127
Mailing Address - Street 1:201 LACKAWANNA AVE STE 314
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1953
Mailing Address - Country:US
Mailing Address - Phone:570-540-9428
Mailing Address - Fax:
Practice Address - Street 1:201 LACKAWANNA AVE STE 314
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1953
Practice Address - Country:US
Practice Address - Phone:570-354-2127
Practice Address - Fax:570-507-9657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-12
Last Update Date:2019-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
PABH001844251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1034027290003Medicaid