Healthcare Provider Details

I. General information

NPI: 1356859284
Provider Name (Legal Business Name): LISA O'BRIEN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 N MAIN ST STE 301
FALL RIVER MA
02720-2133
US

IV. Provider business mailing address

538 CENTER ST
FALL RIVER MA
02724-2765
US

V. Phone/Fax

Practice location:
  • Phone: 774-930-7142
  • Fax:
Mailing address:
  • Phone: 774-930-7142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number125249
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1356859284
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: