Provider Demographics
NPI:1508167966
Name:OLEARY, SHANNON R (BCABA)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:R
Last Name:OLEARY
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8108 SE COCONUT ST
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-4008
Mailing Address - Country:US
Mailing Address - Phone:561-312-3940
Mailing Address - Fax:772-675-9100
Practice Address - Street 1:8108 SE COCONUT ST
Practice Address - Street 2:
Practice Address - City:HOBE SOUND
Practice Address - State:FL
Practice Address - Zip Code:33455-4008
Practice Address - Country:US
Practice Address - Phone:561-312-3940
Practice Address - Fax:772-675-9100
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst