Provider Demographics
NPI:1710450515
Name:O'MEARA, JUSTINE BEACHLEY (MS, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:BEACHLEY
Last Name:O'MEARA
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E OSTEND ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-4309
Mailing Address - Country:US
Mailing Address - Phone:240-425-7239
Mailing Address - Fax:
Practice Address - Street 1:2617 CHRISTIAN ST UNIT A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-2315
Practice Address - Country:US
Practice Address - Phone:240-425-7239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
1-18-29528103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst