Northshore Autism Center, LLC

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

Legal business name

NORTHSHORE AUTISM CENTER, LLC

Practice address

800 Jackson Ave
Mandeville, LA 70448-5328

Phone

(985) 502-1884

Fax

(504) 617-7811

NPI assigned

Dec 9, 2016

Last updated

Jun 3, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Chad Favre, M.S., BCBA, LBANPI 1154692333

Title

Director

Phone

(985) 502-1884

Specialties & licenses 1

Addresses

Locations

Practitioners 5

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.

• Chad Favre, M.S., BCBA

  • Behavior Analyst
  • Mandeville, LA
  • NPI 1154692333
  NPD Authorized official
• Elizabeth Caroline Branch, MA,BCBA

  • Behavior Analyst
  • Mandeville, LA
  • NPI 1972135739
  NPD (past)
• Tara Freeman, BCBA

  • Behavior Analyst
  • Mandeville, LA
  • NPI 1013502939
  NPD (past)
• Savannah Joseph, M.ED, BCBA, LBA

  • Behavior Analyst
  • Mandeville, LA
  • NPI 1962988063
  NPD (past)
• Zoe Gabrielle Stpierre, M.A., BCBA, LBA

  • Behavior Analyst
  • Lacombe, LA
  • NPI 1386393874
  NPD (past)

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

{
    "created_epoch": "1481241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591142400000",
    "number": "1629512652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 FOREST BROOK BLVD",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704488474",
            "telephone_number": "985-502-1884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 JACKSON AVE",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704485328",
            "telephone_number": "985-502-1884",
            "fax_number": "504-617-7811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSHORE AUTISM CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-09",
        "last_updated": "2020-06-03",
        "certification_date": "2020-06-03",
        "status": "A",
        "authorized_official_last_name": "FAVRE",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "985-502-1884",
        "authorized_official_credential": "M.S., BCBA, LBA"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Northshore Allergy & Immunology, LLC
• Northshore Behavior Innovations, LLC
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• Northshore Orthodontics, LLC

• Early Intervention Provider Agency in Mandeville, LA
• Providers in Mandeville, LA by specialty
• Early Intervention Provider Agency in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2020; 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.