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Organization
PETALU'DA AUTISM SERVICES LLC
Active
Organization
PETALU'DA AUTISM SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS KEISHA POWELL SPED/CASD (AUTISM THERAPIST)
(860) 983-8112
Entity
Organization
Contact information
Practice address
6 ELIZABETH LN, VERNON, CT 06066-5056
(860) 983-8112
Mailing address
6 ELIZABETH LN, VERNON, CT 06066-5056
(860) 983-8112
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
11211741
CT
305S00000X
Point of Service
3928518916
CT
Other
Enumeration date
01/23/2013
Last updated
11/08/2014
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