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General NPI Number Information
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NPI Number | 1306230156
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Entity Type | Individual
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Provider Name | VANESSA S ELLIOTT O'LEARY LEWACK BCBA
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Gender | Female
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Dates
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Enumeration Date | 03/18/2015
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Last Update Date | 08/18/2023
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Provider Practice Location Address
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Address Line | 749 E INDUSTRIAL PARK DR
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City | MANCHESTER
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State | NH
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Zip | 03109-5618
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Country | US
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Telephone | 866-352-5010
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Fax |
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Provider Business Mailing Address
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Address Line | 21 CHAMBERLAIN RUN
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City | HINGHAM
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State | MA
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Zip | 02043-1921
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Country | US
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Telephone | 617-827-9136
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Fax |
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 349357
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License Number State | MA
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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 | LABA3414
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License Number State | MA
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