Provider Demographics
NPI:1285038828
Name:GORMLEY, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:GORMLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 NE SURFSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-1244
Mailing Address - Country:US
Mailing Address - Phone:203-300-3257
Mailing Address - Fax:772-218-7284
Practice Address - Street 1:378 NE SURFSIDE AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-1244
Practice Address - Country:US
Practice Address - Phone:203-300-3257
Practice Address - Fax:772-675-9100
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-10
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other