MEDICARE: VERONICA LUIS OBRIEN AMFT

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1740967363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERONICA LUIS OBRIEN AMFT

Provider Business Mailing Address
First Line	:	511 CAPITOLA AVE APT B
Second Line	:
City	:	CAPITOLA
State	:	CA
Zip	:	95010-2795
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	262 NORTH AVE
Second Line	:
City	:	APTOS
State	:	CA
Zip	:	95003-4413
Country	:	US
Telephone Number	:	603-305-3428
Fax Number	:

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

Provider Enumeration Date	:	07/05/2023
Last Update Date	:	07/05/2023

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