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NPI Code Detail

MEDICARE: DR. KEVIN P O'BRIEN PH.D.

MEDICARE: DR. KEVIN P O'BRIEN PH.D.
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
1103G00000XClinical Neuropsychologist1398AZ
2103TA0700XAdult Development & Aging Psychologist1398AZ
3103T00000XPsychologist1398AZ
4103TB0200XCognitive & Behavioral Psychologist1398AZ
5103TF0200XForensic Psychologist1398AZ
6103TP2701XGroup Psychotherapy Psychologist1398AZ
7103TR0400XRehabilitation Psychologist1398AZ

General Provider Information

NPI Number : 1396802369
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEVIN P O'BRIEN PH.D.
Provider Business Mailing Address
First Line : 9832 N HAYDEN RD
Second Line : SUITE 106
City : SCOTTSDALE
State : AZ
Zip : 85258-1298
Country : US
Telephone Number : 480-945-3475
Fax Number : 480-922-5569
Provider Business Practice Location Address
First Line : 9832 N HAYDEN RD
Second Line : SUITE 106
City : SCOTTSDALE
State : AZ
Zip : 85258-1298
Country : US
Telephone Number : 480-945-3475
Fax Number : 480-922-5569
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2007
Last Update Date : 01/11/2008

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