Healthcare Provider Details

I. General information

NPI: 1528982477
Provider Name (Legal Business Name): COLIN O'BRIEN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1371 ABBOTT CT STE A
BUFFALO GROVE IL
60089-2367
US

IV. Provider business mailing address

3232 W VICTORIA ST
CHICAGO IL
60659-3624
US

V. Phone/Fax

Practice location:
  • Phone: 847-777-8995
  • Fax:
Mailing address:
  • Phone: 269-986-2167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number149041364
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: