Provider Demographics
NPI:1336522515
Name:ELS FOR AUTISM FOUNDATION
Entity Type:Organization
Organization Name:ELS FOR AUTISM FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTELO
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA-D, MT-BC
Authorized Official - Phone:561-625-8269
Mailing Address - Street 1:18370 LIMESTONE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3860
Mailing Address - Country:US
Mailing Address - Phone:561-625-8269
Mailing Address - Fax:561-320-9495
Practice Address - Street 1:18370 LIMESTONE CREEK RD
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3860
Practice Address - Country:US
Practice Address - Phone:561-625-8269
Practice Address - Fax:561-320-9495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNH 8400101YM0800X
FLBACB1-11-8447103K00000X
FL03991225A00000X
FL14230225X00000X
FLSA6361235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty