Provider Demographics
NPI:1912669516
Name:CONNELL, TIMOTHY SCOTT II (BCBA)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:SCOTT
Last Name:CONNELL
Suffix:II
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 S ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7152
Mailing Address - Country:US
Mailing Address - Phone:386-402-4460
Mailing Address - Fax:
Practice Address - Street 1:115 S ORANGE ST
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7152
Practice Address - Country:US
Practice Address - Phone:386-402-4460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-21-53951103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst