National Provider Identifier Database

PETALUDA AUTISM SERVICES LLC
Professional


Contact Information

PETALU'DA AUTISM SERVICES LLC
6 ELIZABETH LN
VERNON, CT06066-5056
Phone: 860-983-8112
Fax:
Website:
Specialty Taxonomy Code
* Professional 101YP2500X
Point of Service 305S00000X

* Indicates primary specialty

NPI Profile & details for PETALU'DA AUTISM SERVICES LLC

NPI Number 1245578475
Legal business name
LBN
PETALU'DA AUTISM SERVICES LLC
Authorized official KEISHA POWELL - (AUTISM THERAPIST)
Entity Organization
Organization subpart No
Enumeration date 01/23/2013
Last updated 11/08/2014 - About 12 years ago
Sole proprietor1 Not specified
Identifiers
  • CT License #: 11211741
  • CT License #: 3928518916

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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