Provider Demographics
NPI:1336745215
Name:O'CONNELL, BRITTANY LEE (BCBA LBA)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LEE
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:BCBA LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1073 HARDSCRABBLE RD
Mailing Address - Street 2:
Mailing Address - City:CADYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12918-1906
Mailing Address - Country:US
Mailing Address - Phone:518-569-5441
Mailing Address - Fax:
Practice Address - Street 1:22 NEW YORK RD
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12903-3981
Practice Address - Country:US
Practice Address - Phone:518-561-3803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001967103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst