MEDICARE: MAUREEN O'BRIEN MSW, LCSW, ACSW

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	R035259-1	NY

General Provider Information

NPI Number	:	1326097817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUREEN O'BRIEN MSW, LCSW, ACSW

Provider Business Mailing Address
First Line	:	560 DELAWARE AVE
Second Line	:	FLOOR 1
City	:	ALBANY
State	:	NY
Zip	:	12209-1415
Country	:	US
Telephone Number	:	518-462-0213
Fax Number	:

Provider Business Practice Location Address
First Line	:	560 DELAWARE AVE
Second Line	:	FLOOR 1
City	:	ALBANY
State	:	NY
Zip	:	12209-1415
Country	:	US
Telephone Number	:	518-462-0213
Fax Number	:

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	07/08/2007

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