Healthcare Provider Details

I. General information

NPI: 1033883921
Provider Name (Legal Business Name): O'CONNELL BEHAVIORAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 USEPPA DR
AVE MARIA FL
34142-5076
US

IV. Provider business mailing address

5340 USEPPA DR
AVE MARIA FL
34142-5076
US

V. Phone/Fax

Practice location:
  • Phone: 239-316-7656
  • Fax:
Mailing address:
  • Phone: 239-316-7656
  • 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: MRS. CAROLYN O'CONNELL
Title or Position: OWNER
Credential: BCBA
Phone: 239-316-7656