Healthcare Provider Details

I. General information

NPI: 1770820714
Provider Name (Legal Business Name): SEAN J OBRIEN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2013
Last Update Date: 02/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 LAWRENCE BROOK DR
EAST BRUNSWICK NJ
08816-1111
US

IV. Provider business mailing address

19 LAWRENCE BROOK DR
EAST BRUNSWICK NJ
08816-1111
US

V. Phone/Fax

Practice location:
  • Phone: 732-501-5733
  • Fax:
Mailing address:
  • Phone: 732-501-5733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05530000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: