Basic Information
| Provider Information | |||||||||
| NPI: | 1821434069 | ||||||||
| 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: | 05/15/2013 | ||||||||
| LastUpdateDate: | 05/15/2013 | ||||||||
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| AuthorizedOfficialLastName: | ELSKY | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
| AuthorizedOfficialMiddleName: | MARTIN | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3107879334 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSY.D., MFT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-08-4884 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.