Healthcare Provider Details

I. General information

NPI: 1275458945
Provider Name (Legal Business Name): COLLEEN R O'KEEFE BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 BLOOMINGDALE AVE APT 305
WAYNE PA
19087-4049
US

IV. Provider business mailing address

107 BLOOMINGDALE AVE APT 305
WAYNE PA
19087-4049
US

V. Phone/Fax

Practice location:
  • Phone: 610-755-1496
  • Fax:
Mailing address:
  • Phone: 610-755-1496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-82731
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: