Healthcare Provider Details

I. General information

NPI: 1932734894
Provider Name (Legal Business Name): JESSICA OBRIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MILL ST
BELMONT MA
02478-1064
US

IV. Provider business mailing address

115 MILL ST
BELMONT MA
02478-1064
US

V. Phone/Fax

Practice location:
  • Phone: 617-855-2274
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number126996
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: