Healthcare Provider Details

I. General information

NPI: 1326607680
Provider Name (Legal Business Name): JENNIFER OBRIEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 CARLETON ST
CAMBRIDGE MA
02142-1323
US

IV. Provider business mailing address

909 SOUTH ST
ROSLINDALE MA
02131-2411
US

V. Phone/Fax

Practice location:
  • Phone: 617-253-2916
  • Fax: 617-253-0162
Mailing address:
  • Phone: 413-519-7725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number10227
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: