Healthcare Provider Details

I. General information

NPI: 1982123832
Provider Name (Legal Business Name): ELIZABETH KEELY O'NEIL BCBA, LABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2017
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 WASHINGTON ST BLDG P
NORWELL MA
02061-1740
US

IV. Provider business mailing address

45 BRAESIDE RD
FALMOUTH MA
02540-3007
US

V. Phone/Fax

Practice location:
  • Phone: 781-290-3886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1485
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: