Basic Information
| Provider Information | |||||||||
| NPI: | 1598256299 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARDINAL AUTISM SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7360 N LINCOLN AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | LINCOLNWOOD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 607121705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479721824 | ||||||||
| FaxNumber: | 8558552712 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 S STATE ROAD 7 STE 106 | ||||||||
| Address2: | |||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333174044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8558552712 | ||||||||
| FaxNumber: | 8558552712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2018 | ||||||||
| LastUpdateDate: | 05/29/2018 | ||||||||
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| AuthorizedOfficialLastName: | WEINBERGER | ||||||||
| AuthorizedOfficialFirstName: | SHMUEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8479721824 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.