Healthcare Provider Details

I. General information

NPI: 1699691311
Provider Name (Legal Business Name): MATHEW OBRIEN MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 NE 7TH AVE
GAINESVILLE FL
32601-4391
US

IV. Provider business mailing address

1709 SW 49TH PL
GAINESVILLE FL
32608-3932
US

V. Phone/Fax

Practice location:
  • Phone: 352-672-4715
  • Fax:
Mailing address:
  • Phone: 352-672-4715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18279
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: