Provider Demographics
NPI:1063947927
Name:O'KELLY, CARONI PATRICIA
Entity type:Individual
Prefix:
First Name:CARONI
Middle Name:PATRICIA
Last Name:O'KELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16782 NW STATE ROAD 45 STE C
Mailing Address - Street 2:
Mailing Address - City:HIGH SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32643-3309
Mailing Address - Country:US
Mailing Address - Phone:561-809-3282
Mailing Address - Fax:
Practice Address - Street 1:16782 NW STATE ROAD 45 STE C
Practice Address - Street 2:
Practice Address - City:HIGH SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32643-3309
Practice Address - Country:US
Practice Address - Phone:561-809-3282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician