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General NPI Number Information
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NPI Number | 1710450515
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Entity Type | Individual
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Provider Name | JUSTINE BEACHLEY O'MEARA MS, BCBA, LBA
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Gender | Female
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Dates
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Enumeration Date | 01/04/2019
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Last Update Date | 03/23/2023
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Provider Practice Location Address
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Address Line | 2617 CHRISTIAN ST UNIT A
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City | PHILADELPHIA
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State | PA
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Zip | 19146-2315
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Country | US
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Telephone | 240-425-7239
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Fax |
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Provider Business Mailing Address
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Address Line | 111 E OSTEND ST
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City | BALTIMORE
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State | MD
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Zip | 21230-4309
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Country | US
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Telephone | 240-425-7239
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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 |
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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 | 1-18-29528
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License Number State |
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