Healthcare Provider Details

I. General information

NPI: 1831016716
Provider Name (Legal Business Name): EILIS O'CONNELL LBA, BCBA-D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EILIS O'CONNELL-SUSSMAN LBA, BCBA-D

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2169 JONES AVE
WANTAGH NY
11793-3845
US

IV. Provider business mailing address

2169 JONES AVE
WANTAGH NY
11793-3845
US

V. Phone/Fax

Practice location:
  • Phone: 516-659-5002
  • Fax:
Mailing address:
  • Phone: 516-659-5002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number001972
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: