Provider Demographics
NPI:1992545842
Name:O'BOYLE, CHARLES J III (BCBA)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:O'BOYLE
Suffix:III
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 1:9812 MARTHA LN
Mailing Address - Street 2:
Mailing Address - City:RIVER RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70123-1514
Mailing Address - Country:US
Mailing Address - Phone:504-481-7268
Mailing Address - Fax:
Practice Address - Street 1:1520 KUEBEL ST STE 4
Practice Address - Street 2:
Practice Address - City:ELMWOOD
Practice Address - State:LA
Practice Address - Zip Code:70123-6975
Practice Address - Country:US
Practice Address - Phone:504-833-6730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst