Healthcare Provider Details

I. General information

NPI: 1295023133
Provider Name (Legal Business Name): CAROLYN DOREY O'CONNELL M.S., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3788 HUDSON CT
NAPLES FL
34116-7325
US

IV. Provider business mailing address

3788 HUDSON CT
NAPLES FL
34116-7325
US

V. Phone/Fax

Practice location:
  • Phone: 239-784-4989
  • Fax:
Mailing address:
  • Phone: 239-784-4989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-11-7957
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: