Healthcare Provider Details

I. General information

NPI: 1083251185
Provider Name (Legal Business Name): PATRICIA OBRIEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2019
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 CAMINO DEL RIO S STE 303
SAN DIEGO CA
92108-3757
US

IV. Provider business mailing address

2535 CAMINO DEL RIO S STE 303
SAN DIEGO CA
92108-3757
US

V. Phone/Fax

Practice location:
  • Phone: 619-777-6870
  • Fax:
Mailing address:
  • Phone: 619-777-6870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW22761
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22761
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number75267
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: