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General NPI Number Information
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NPI Number | 1285038828
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Entity Type | Individual
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Provider Name | ERIC GORMLEY
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Gender | Male
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Dates
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Enumeration Date | 10/10/2014
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 1901 MAIN ST FL 18TH
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City | COLUMBIA
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State | SC
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Zip | 29201-2443
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Country | US
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Telephone | 203-300-3257
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Fax |
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Provider Business Mailing Address
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Address Line | 378 NE SURFSIDE AVE
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City | PORT ST LUCIE
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State | FL
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Zip | 34983-1244
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Country | US
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Telephone | 203-300-3257
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Fax | 772-218-7284
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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