Healthcare Provider Details

I. General information

NPI: 1346383130
Provider Name (Legal Business Name): PATRICIA EILEEN OBRIEN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46360 GRATIOT AVE
CHESTERFIELD MI
48051-2800
US

IV. Provider business mailing address

46360 GRATIOT AVE
CHESTERFIELD MI
48051-2800
US

V. Phone/Fax

Practice location:
  • Phone: 158-694-8022
  • Fax: 586-948-0213
Mailing address:
  • Phone: 158-694-8022
  • Fax: 586-948-0213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301008644
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: