MEDICARE: CHARLES EDWARD O'BRIEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LC13416	ME

General Provider Information

NPI Number	:	1164759221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES EDWARD O'BRIEN

Provider Business Mailing Address
First Line	:	217 BEACH RD
Second Line	:
City	:	LINCOLNVILLE
State	:	ME
Zip	:	04849-5402
Country	:	US
Telephone Number	:	207-380-3899
Fax Number	:

Provider Business Practice Location Address
First Line	:	62 BAY VIEW ST
Second Line	:
City	:	CAMDEN
State	:	ME
Zip	:	04843-2252
Country	:	US
Telephone Number	:	207-380-3899
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2009
Last Update Date	:	04/30/2026

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