Healthcare Provider Details

I. General information

NPI: 1992687628
Provider Name (Legal Business Name): CASEY OBRIEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W SAMPLE RD STE 112
COCONUT CREEK FL
33073-3457
US

IV. Provider business mailing address

4400 W SAMPLE RD STE 112
COCONUT CREEK FL
33073-3457
US

V. Phone/Fax

Practice location:
  • Phone: 954-947-6971
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW25030
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: