Resource Directory Provider Portal Please fill out this information ONLY if you work with people with autism. We are compiling a database of service providers and resources for our community, specializing in autism. As the autism resource center for all of western Massachusetts, we pride ourselves in having relevant and up to date resources available to our community members. Hundreds of families, professionals, and individuals will have access to our database. 1. Organization/Provider Name : 2. Phone number (write N/A if none) : 3. Website URL (write N/A if none) : 4. Contact name (write N/A if none) : 5. Contact email address (write N/A if none) : 6. Address : Post Office Box # : City/Town : State/Province : ZIP/Postal Code : 7. County (check all counties that you serve) : Hampden Hampshire Franklin Berkshire Outside of Western Massachusetts 8. Are you based out of more than one location? : Yes No List towns where you have other offices in Massachusetts : 9. Organizational description (limit 500 characters) : 10. Highlight specific autism therapy(s) you provide: Applied Behavioral Analysis (ABA) Counselors and social workers Equine Therapy Music/Dance/Art Sensory Integration Social Skills Speech & Language Other 11. Choose the category your organization best fits into (select all that apply) : Education Employment Financial Resources Health Services Interventions Legal Resources Recreation Respite / Residential State Agencies Support Groups Technology Therapy Others 12. Choose the sub-category your organization best fits into (select all that apply): >Education > Educational Advocates >Education > Educational Assessments >Education > Schools >Education > SPED PACS >Education > Post-Secondary Education >Employment > Employment Services >Employment > Vocational Support >Financial Resources > Family Grant Opportunities >Financial Resources > Financial Assistance Programs >Financial Resources > Financial Planners >Health Services > Autism Diagnostics >Health Services > Dental Services >Health Services > Diet/Nutrition >Health Services > Gastroenterologists >Health Services > Neurologists >Health Services > Pediatrics >Health Services > Physical Therapy >Health Services > Psychiatrists >Health Services > Psychologists >Interventions > Crisis Intervention >Interventions > Early Intervention >Legal Resources > Advocates >Legal Resources > Attorneys >Recreation > Activities >Recreation > Camps >Respite / Residential > After-School Programs >Respite / Residential > Day Programs >Respite / Residential > Overnight Respite Facilities >Respite / Residential > Residential Services >Respite / Residential > Respite Care >State Agencies > State Agencies >Support Groups > Parent / Family Support >Support Groups > Peer Support >Technology > Assistive Technology >Technology > Augmentative Communication >Therapy > Applied Behavior Analysis (ABA) >Therapy > Counselors & Social Workers >Therapy > Equine Therapy >Therapy > Music / Dance / Art Therapy >Therapy > Sensory Integration Therapy >Therapy > Social Skills Therapy >Therapy > Speech & Language Therapy >Adult Services >Aspergers >Auditory integration >Autism Consultant >Direct Care Providers >Doctors >Occupational Therapists >Peer Support >Recreational Services >Sacro-cranial Therapists >Sexuality Issues Supports >Social Skills Trainers/Groups >Statewide Autism Supports >Transition/Transition Assistance 13. Age groups you serve (select all that apply) : Young Child (0-4) School Age (5-21) Adult (22+) Other Grouping 14. Populations you serve (select all that apply) : Females Males LGBTQ+ Multicultural Immigrant/Refugee Other (please specify) 15. Languages spoken (select all that apply) : English Spanish French Chinese Russian Polish Swahili Other (please specify) 16. Do you accept MassHealth? : Yes No 17. Do you offer a wait list? : Yes No About how long a wait before a client may be seen? 18. Other insurance you accept (list all that apply or "N/A") : Other (please specify - note that we will use our discretion whether a new sub-category needs to be added or whether your submission fits into a pre-existing sub-category)
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