Provider Demographics
NPI:1114248176
Name:O'CONNOR, RYAN (MA, BCBA, CBM-NP)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:MA, BCBA, CBM-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:862 LIVE OAK LN
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9533
Mailing Address - Country:US
Mailing Address - Phone:407-900-4060
Mailing Address - Fax:
Practice Address - Street 1:2710 STATEN AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4211
Practice Address - Country:US
Practice Address - Phone:407-965-3018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-09-5885103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst