Individual provider Active NPI

Lacee O'Shea, BCBA

  • Behavior Analyst
  • Port Orange, FL
National Provider Identifier
1033667985
Registry record updated Mar 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
1-22-59144 Issued in FL
Practice address
6824 Vintage LN
Port Orange, FL 32128-4093
Phone
(757) 375-3461
NPI assigned
Sep 20, 2016
Last updated
Mar 19, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X
Behavior Technician 106S00000X RBT-19-91328 FL
Behavior Analyst 103K00000X 1-22-59144 FL Primary

Addresses

Primary practice location

6824 Vintage LN
Port Orange, FL 32128-4093

Mailing address

1202 Tech Blvd Ste 103
Tampa, FL 33619-7863
Phone (813) 438-6796

Other practice location 1

5325 16th St
Vero Beach, FL 32966-2316
Phone (309) 453-4341

Other practice location 2

121 N Highland St
Mount Dora, FL 32757-5764
Phone (352) 720-5194

Other practice location 3

500 E Colonial Dr
Orlando, FL 32803-4510
Phone (407) 218-4340

Other practice location 4

17435 US Highway 441 Ste 101
Mount Dora, FL 32757-6750
Phone (352) 434-0455

Other identifiers 1

IdentifierTypeStateIssuer
105097600MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
RBT-19-91328FLMDBehavior Technician

Practice roles

OrganizationSpecialtyStatusNew patients
Metamorphosis Therapy, LLC Behavior Analyst Current Accepting new patients
Metamorphosis Therapy LLC Behavior Analyst Current Accepting new patients
Ertel ABA LLC CurrentSince Mar 24, 2025 Accepting new patients
KNR Therapy, LLC Behavior Analyst CurrentSince May 1, 2022 Accepting new patients
Florida Autism Center Behavior Analyst Past Accepting new patients

Locations

1202 Tech Blvd
Ste 103
Tampa, FL 33619
Phone (813) 547-5413

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1474329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742342400000",
    "number": "1033667985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 TECH BLVD STE 103",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336197863",
            "telephone_number": "813-438-6796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6824 VINTAGE LN",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321284093",
            "telephone_number": "757-375-3461"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5325 16th St",
            "address_purpose": "LOCATION",
            "city": "Vero Beach",
            "state": "FL",
            "postal_code": "329662316",
            "country_code": "US",
            "telephone_number": "309-453-4341",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "121 N Highland St",
            "address_purpose": "LOCATION",
            "city": "Mount Dora",
            "state": "FL",
            "postal_code": "327575764",
            "country_code": "US",
            "telephone_number": "352-720-5194",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "500 E Colonial Dr",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328034510",
            "country_code": "US",
            "telephone_number": "407-218-4340",
            "fax_number": "407-218-4303",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "17435 US Highway 441 Ste 101",
            "address_purpose": "LOCATION",
            "city": "Mount Dora",
            "state": "FL",
            "postal_code": "327576750",
            "country_code": "US",
            "telephone_number": "352-434-0455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "O'SHEA",
        "first_name": "LACEE",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-20",
        "last_updated": "2025-03-19",
        "certification_date": "2025-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "FL",
            "license": "RBT-19-91328",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "FL",
            "license": "1-22-59144",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "105097600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orange, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.