Organization
AUTISM DELAWARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM ROSEBAUM (ADMIN BILLER)
(302) 224-6020
Entity
Organization
Contact information
Practice address
924 OLD HARMONY RD, SUITE 201, NEWARK, DE 19713-4184
(302) 224-6020
(302) 224-6017
Mailing address
924 OLD HARMONY RD, SUITE 201, NEWARK, DE 19713-4186
(302) 224-6020
(302) 224-6017
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
—
—
103TR0400X
Rehabilitation Psychologist
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
302R00000X
Health Maintenance Organization
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000204
—
DE
05
—
221000204
—
DE
05
—
222000204
—
DE
Enumeration date
03/01/2012
Last updated
05/25/2021
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