Provider Demographics
NPI:1881951341
Name:AUTISM AND EARLY INTERVENTION
Entity type:Organization
Organization Name:AUTISM AND EARLY INTERVENTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ZOE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIGEL
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:505-577-9515
Mailing Address - Street 1:826 CAMINO DEL MONTE REY
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3977
Mailing Address - Country:US
Mailing Address - Phone:505-577-9515
Mailing Address - Fax:
Practice Address - Street 1:826 CAMINO DEL MONTE REY
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3977
Practice Address - Country:US
Practice Address - Phone:505-577-9515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3138561041S0200X
NMI-061521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty