Healthcare Provider Details

I. General information

NPI: 1003439092
Provider Name (Legal Business Name): ELIZABETH OBRIEN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2020
Last Update Date: 05/25/2020
Certification Date: 05/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 CLARK ST
ARLINGTON MA
02476-4223
US

IV. Provider business mailing address

24 CLARK ST
ARLINGTON MA
02476-4223
US

V. Phone/Fax

Practice location:
  • Phone: 617-818-4552
  • Fax:
Mailing address:
  • Phone: 617-818-4552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7988
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: