Healthcare Provider Details

I. General information

NPI: 1659956258
Provider Name (Legal Business Name): MAUREEN A OBRIEN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 MARLBOROUGH ST APT 904
BOSTON MA
02115-1508
US

IV. Provider business mailing address

416 MARLBOROUGH ST APT 904
BOSTON MA
02115-1508
US

V. Phone/Fax

Practice location:
  • Phone: 401-738-7989
  • Fax:
Mailing address:
  • Phone: 401-738-7989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: