Healthcare Provider Details

I. General information

NPI: 1962151282
Provider Name (Legal Business Name): ERCILIA MIGUELINA O'NEAL BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7090 SAMUEL MORSE DR STE 100
COLUMBIA MD
21046-3444
US

IV. Provider business mailing address

5735 HOWARD DR
GLEN BURNIE MD
21061-2196
US

V. Phone/Fax

Practice location:
  • Phone: 855-935-3691
  • Fax:
Mailing address:
  • Phone: 954-325-3411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-77013
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: