Healthcare Provider Details

I. General information

NPI: 1124205224
Provider Name (Legal Business Name): MARGARET ALICE OBRIEN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 SANFORD ROAD THE PROFESSIONAL CENTER
WELLS ME
04090-5327
US

IV. Provider business mailing address

146 FLINTLOCK VILLAGE UNIT 2
WELLS ME
04090-5327
US

V. Phone/Fax

Practice location:
  • Phone: 207-646-8391
  • Fax: 801-846-8396
Mailing address:
  • Phone: 207-251-4027
  • Fax: 801-846-8396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCC3024
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3015042
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number867
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: