Provider Demographics
NPI:1316352966
Name:O'DELL, ALYCIA MARIE (BCBA)
Entity type:Individual
Prefix:
First Name:ALYCIA
Middle Name:MARIE
Last Name:O'DELL
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-2652
Mailing Address - Country:US
Mailing Address - Phone:407-375-0823
Mailing Address - Fax:
Practice Address - Street 1:2062 N COURTENAY PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4285
Practice Address - Country:US
Practice Address - Phone:321-305-5576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60958589103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst