Healthcare Provider Details

I. General information

NPI: 1598898009
Provider Name (Legal Business Name): SHERRIE L OBRIEN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 W REDONDO BEACH BLVD SUITE 204
GARDENA CA
90248-1612
US

IV. Provider business mailing address

3512 PACIFIC AVE #2
MARINA DEL REY CA
90292-5752
US

V. Phone/Fax

Practice location:
  • Phone: 310-352-6422
  • Fax: 310-352-6480
Mailing address:
  • Phone: 310-352-6422
  • Fax: 310-352-6480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number8013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: