Healthcare Provider Details

I. General information

NPI: 1760026231
Provider Name (Legal Business Name): DENNIS KELLY O'BRIEN LCSW, CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7433 N CLARK ST
CHICAGO IL
60626-1619
US

IV. Provider business mailing address

3450 OAKTON ST STE 300
SKOKIE IL
60076-2951
US

V. Phone/Fax

Practice location:
  • Phone: 773-338-8778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: