Healthcare Provider Details

I. General information

NPI: 1285038828
Provider Name (Legal Business Name): ERIC GORMLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2014
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 MAIN ST FL 18TH
COLUMBIA SC
29201-2443
US

IV. Provider business mailing address

378 NE SURFSIDE AVE
PORT ST LUCIE FL
34983-1244
US

V. Phone/Fax

Practice location:
  • Phone: 203-300-3257
  • Fax:
Mailing address:
  • Phone: 203-300-3257
  • Fax: 772-218-7284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: