Healthcare Provider Details

I. General information

NPI: 1043314370
Provider Name (Legal Business Name): JOHN R OBRIEN ED D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LONG POND ROAD STE 210
PLYMOUTH MA
02360
US

IV. Provider business mailing address

110 LONG POND ROAD STE 210
PLYMOUTH MA
02360
US

V. Phone/Fax

Practice location:
  • Phone: 508-746-8004
  • Fax: 508-746-8099
Mailing address:
  • Phone: 508-746-8004
  • Fax: 508-746-8099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1298
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: