Healthcare Provider Details

I. General information

NPI: 1962486746
Provider Name (Legal Business Name): MAUREEN CATHERINE OBRIEN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 W MAIN ST #2D
WATERBURY CT
06708-2653
US

IV. Provider business mailing address

57 WOODS RD
BETHANY CT
06524-3103
US

V. Phone/Fax

Practice location:
  • Phone: 203-573-8555
  • Fax: 203-597-9565
Mailing address:
  • Phone: 203-393-2280
  • Fax: 203-393-2241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number002518
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: