Provider Demographics
NPI:1023491933
Name:O'CONNOR, MICHELLE BRENNAN (BCBA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:BRENNAN
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:DIANE
Other - Last Name:BRENNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:43 GEORGES HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1043
Mailing Address - Country:US
Mailing Address - Phone:203-947-0829
Mailing Address - Fax:
Practice Address - Street 1:43 GEORGES HILL RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1043
Practice Address - Country:US
Practice Address - Phone:203-947-0829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-15-18955103K00000X
CT11103K00000X
UT13481534-2506103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst