08D2208079 CLIA NUMBER - AUTISM DELAWARE

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Laboratory Demographics

CLIA Number: 08D2208079

Facility Name: AUTISM DELAWARE

Facility Address:
624 OLD HARMONY ROAD, SUITE 201
NEWARK, DE
ZIP 19713
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Facility Phone Number: 302 224-6020

Facility Type: Other - HOME AND COMMUNITY BASED

Certificate Type: Waiver

NPI Number: 1326312885

Taxonomy: 103TM1800X - Psychologist

CLIA Record

Field Name	Field Value
CLIA Number	08D2208079
LAB Type	Other - HOME AND COMMUNITY BASED
Facility Name	AUTISM DELAWARE
Street	624 OLD HARMONY ROAD, SUITE 201
City	NEWARK
State	DE
ZIP	19713
Phone	302 224-6020
CertificateType	4
CertificateEffectiveDate	1/4/2023
CertificateExpirationDate	1/3/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024