Healthcare Provider Details

I. General information

NPI: 1962088062
Provider Name (Legal Business Name): SHANNON O'BRIEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2021
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CALIFORNIA DRIVE
VACAVILLE CA
95696-2237
US

IV. Provider business mailing address

626 W LANCASTER BLVD UNIT 128
LANCASTER CA
93534-3108
US

V. Phone/Fax

Practice location:
  • Phone: 707-448-6841
  • Fax:
Mailing address:
  • Phone: 661-434-5997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number89763
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904014443
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102476
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06383300
License Number StateNJ
# 5
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: