Healthcare Provider Details

I. General information

NPI: 1902439995
Provider Name (Legal Business Name): ERIC GORMLEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 08/27/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W CAPITOL AVE STE 1700
LITTLE ROCK AR
72201-3438
US

IV. Provider business mailing address

378 NE SURFSIDE AVE
PORT ST LUCIE FL
34983-1244
US

V. Phone/Fax

Practice location:
  • Phone: 501-999-3836
  • Fax: 501-361-1385
Mailing address:
  • Phone: 203-300-3257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: ERIC A GORMLEY
Title or Position: AMBR
Credential:
Phone: 203-300-3257