Healthcare Provider Details

I. General information

NPI: 1679010730
Provider Name (Legal Business Name): KATHLEEN SAMS O'NEIL MS, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2017
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 AVEMORE SQUARE PL
CHARLOTTESVILLE VA
22911-7228
US

IV. Provider business mailing address

3040 AVEMORE SQUARE PL
CHARLOTTESVILLE VA
22911-7228
US

V. Phone/Fax

Practice location:
  • Phone: 434-220-0089
  • Fax: 434-220-0089
Mailing address:
  • Phone: 434-220-0089
  • Fax: 434-220-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133000551
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: