Basic Information
| Provider Information | |||||||||
| NPI: | 1588982490 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEHAVIORAL EDUCATION FOR CHILDREN WITH AUTISM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 369 VAN NESS WAY | ||||||||
| Address2: | SUITE 710 | ||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905011489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107879334 | ||||||||
| FaxNumber: | 3107878626 | ||||||||
| Practice Location | |||||||||
| Address1: | 369 VAN NESS WAY | ||||||||
| Address2: | SUITE 710 | ||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905011489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107879334 | ||||||||
| FaxNumber: | 3107878626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2010 | ||||||||
| LastUpdateDate: | 08/02/2012 | ||||||||
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| AuthorizedOfficialLastName: | ELSKY | ||||||||
| AuthorizedOfficialFirstName: | GREG | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3107879334 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D, BCBA-D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | 1A-19-155 | CA | N | Agencies | Case Management | 251S00000X | 1A-19-155 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.