Provider Demographics
NPI:1033883921
Name:O'CONNELL BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:O'CONNELL BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:239-316-7656
Mailing Address - Street 1:5340 USEPPA DR
Mailing Address - Street 2:
Mailing Address - City:AVE MARIA
Mailing Address - State:FL
Mailing Address - Zip Code:34142-5076
Mailing Address - Country:US
Mailing Address - Phone:239-316-7656
Mailing Address - Fax:
Practice Address - Street 1:5340 USEPPA DR
Practice Address - Street 2:
Practice Address - City:AVE MARIA
Practice Address - State:FL
Practice Address - Zip Code:34142-5076
Practice Address - Country:US
Practice Address - Phone:239-316-7656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty