Healthcare Provider Details

I. General information

NPI: 1285814210
Provider Name (Legal Business Name): STEVEN PATRICK OBRIEN PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 SO MYRTLE AVE
CLEARWATER FL
33756
US

IV. Provider business mailing address

1227 SO MYRTLE AVE
CLEARWATER FL
33756
US

V. Phone/Fax

Practice location:
  • Phone: 727-449-2628
  • Fax: 727-466-0478
Mailing address:
  • Phone: 727-449-2628
  • Fax: 727-466-0478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY5125
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: