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Organization
THE AUTISM SPARK LLC
Active
Organization
THE AUTISM SPARK LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS CYNTHIA AZU BSC (CO-CHIEF EXECUTIVE OFFICER(CO-CEO))
(774) 232-4597
Entity
Organization
Contact information
Practice address
30 STEFANIAK AVE, WEBSTER, MA 01570-2032
(774) 232-4597
Mailing address
30 STEFANIAK AVE, WEBSTER, MA 01570-2032
(774) 232-4597
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
10/26/2018
Last updated
10/26/2018
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