Healthcare Provider Details

I. General information

NPI: 1285828541
Provider Name (Legal Business Name): JEREMY COLE O'BRIEN LCSW, MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N OCCIDENTAL BLVD
LOS ANGELES CA
90026-4641
US

IV. Provider business mailing address

155 N OCCIDENTAL BLVD
LOS ANGELES CA
90026-4641
US

V. Phone/Fax

Practice location:
  • Phone: 213-381-2931
  • Fax:
Mailing address:
  • Phone: 213-381-2931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number216465
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number29480
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 62654
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: