NPIMap

Organization Active NPI

Pennsylvania Autism Action Center LLC

  • Behavior Analyst
  • Brodheadsville, PA
National Provider Identifier
1568809275
Registry record updated Mar 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
1-03-1139 Issued in PA
Legal business name
PENNSYLVANIA AUTISM ACTION CENTER LLC
Practice address
2071 Route 209
Brodheadsville, PA 18322-7754
Phone
(570) 992-6720
Fax
(570) 992-6736
NPI assigned
Jun 4, 2013
Last updated
Mar 9, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2017

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

Authorized official

Name
Mrs. Michelle Meaeny Demarsh, MED
Title
Principal Owner
Phone
(570) 992-6720

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Occupational Therapist 225XP0200X
Behavior Analyst 103K00000X 1-03-1139 PA Primary

Addresses

Primary practice location

2071 Route 209
Brodheadsville, PA 18322-7754

Mailing address

2071 Route 209
Brodheadsville, PA 18322-7754
Phone (570) 992-6720

National Provider Directory

National Provider Directory
Tax ID family
Pennsylvania Autism Action Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

212 Kevin Ln
Brodheadsville, PA 18322
Phone (570) 972-6720

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1370304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489017600000",
    "number": "1568809275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2071 ROUTE 209",
            "city": "BRODHEADSVILLE",
            "state": "PA",
            "postal_code": "183227754",
            "telephone_number": "570-992-6720",
            "fax_number": "570-992-6736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2071 ROUTE 209",
            "city": "BRODHEADSVILLE",
            "state": "PA",
            "postal_code": "183227754",
            "telephone_number": "570-992-6720",
            "fax_number": "570-992-6736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNSYLVANIA AUTISM ACTION CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-04",
        "last_updated": "2017-03-09",
        "status": "A",
        "authorized_official_last_name": "DEMARSH",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "MEAENY",
        "authorized_official_title_or_position": "PRINCIPAL OWNER",
        "authorized_official_telephone_number": "570-992-6720",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MED"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "PA",
            "license": "1-03-1139",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brodheadsville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2017; 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.