Healthcare Provider Details
I. General information
NPI: 1336230986
Provider Name (Legal Business Name): MAUREEN O BRIEN MSSA LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 09/27/2006
Last Update Date: 03/31/2023
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
20 GROVE STREET PETERBOROUGH CLINICAL ASSOCIATES
PETERBOROUGH NH
03458
US
IV. Provider business mailing address
PO BOX 125
FITZWILLIAM NH
03447
US
V. Phone/Fax
- Phone: 603-924-7462
- Fax: 603-924-2138
- Phone: 603-924-7462
- Fax: 603-924-2138
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | 240 |
| License Number State | NH |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | 1015861 |
| License Number State | MA |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | NH240 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | AETNA |
| # 2 | |
| Identifier | P07848 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | BLUE CROSS MA |
| # 3 | |
| Identifier | 1039550 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | BEACON HEALTH |
| # 4 | |
| Identifier | 80001345 |
| Identifier Type | MEDICAID |
| Identifier State | NH |
| Identifier Issuer | |
| # 5 | |
| Identifier | NH240 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | NAHGA |
| # 6 | |
| Identifier | 006245 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | VALUE OPTIONS |
| # 7 | |
| Identifier | NH240 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | C B A |
| # 8 | |
| Identifier | NH240 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | HEALTH CARE VALUE MANAGEM |
| # 9 | |
| Identifier | 1402015Y0NH01 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | ANTHEM |
| # 10 | |
| Identifier | 15398 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | CIGNA |
| # 11 | |
| Identifier | NH240 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | BENEFIT PLAN |
| # 12 | |
| Identifier | NH240 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | PBH |
| # 13 | |
| Identifier | NH240 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | TRICARE |
| # 14 | |
| Identifier | NH240 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | UBH |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
