MEDICARE: SOFIA ERIN O'LEARY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-25-79570	FL
2	106S00000X	Behavior Technician	RBT-22-228197	FL

General Provider Information

NPI Number	:	1467059584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOFIA ERIN O'LEARY

Provider Business Mailing Address
First Line	:	542 AMHERST ST
Second Line	:
City	:	NASHUA
State	:	NH
Zip	:	03063-1016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4163 NW FEDERAL HWY
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-3623
Country	:	US
Telephone Number	:	772-773-1975
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2020
Last Update Date	:	03/10/2025

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Directions to “ SOFIA ERIN O'LEARY ” Practice Location

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