Provider Demographics
NPI:1417581836
Name:O'DEA, SEAN (MAT, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:O'DEA
Suffix:
Gender:M
Credentials:MAT, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9754 RED CLOVER CT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-1870
Mailing Address - Country:US
Mailing Address - Phone:443-928-0492
Mailing Address - Fax:
Practice Address - Street 1:14550 YORK RD STE A
Practice Address - Street 2:
Practice Address - City:SPARKS GLENCOE
Practice Address - State:MD
Practice Address - Zip Code:21152-9307
Practice Address - Country:US
Practice Address - Phone:410-215-0455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLBA763103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst