Petalu'Da Autism Services LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

11211741 Issued in CT

Legal business name

PETALU'DA AUTISM SERVICES LLC

Practice address

6 Elizabeth LN
Vernon, CT 06066-5056

Phone

(860) 983-8112

NPI assigned

Jan 23, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Miss Keisha Powell, SPED/CASDNPI 1831519016

Title

Autism Therapist

Phone

(860) 983-8112

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Keisha Powell, PHD, CAS, ABS, ATS

  • Specialist
  • Broad Brook, CT
  • NPI 1831519016

  Multi-Specialty

  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415404800000",
    "number": "1245578475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 ELIZABETH LN",
            "city": "VERNON",
            "state": "CT",
            "postal_code": "060665056",
            "telephone_number": "860-983-8112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 ELIZABETH LN",
            "city": "VERNON",
            "state": "CT",
            "postal_code": "060665056",
            "telephone_number": "860-983-8112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETALU'DA AUTISM SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-23",
        "last_updated": "2014-11-08",
        "status": "A",
        "authorized_official_last_name": "POWELL",
        "authorized_official_first_name": "KEISHA",
        "authorized_official_title_or_position": "AUTISM THERAPIST",
        "authorized_official_telephone_number": "860-983-8112",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "SPED/CASD"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "CT",
            "license": "11211741",
            "primary": true
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "CT",
            "license": "3928518916",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Swati J Patel, APRN
• Pathway to Peace, LLC
• Peace of Mind Behavioral Health Solutions LLC
• Erin Perry, APRN
• Emilie Karen Pessagno, OTRL
• Christina Lynn Pettengill, MA, BCBA, LBA
• Mackenzie Phelps, LCSW
• Marlaine Philpotts, R.D.
• Pioneer Health Compounding Pharmcacy
• Karen Piorkowski, M.D.

• Professional Counselor in Vernon, CT
• Providers in Vernon, CT by specialty
• Professional Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.