Healthcare Provider Details

I. General information

NPI: 1821289307
Provider Name (Legal Business Name): DAN T OBRIEN MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 QUANTUM RD NE
RIO RANCHO NM
87124-4502
US

IV. Provider business mailing address

PO BOX 28220
SANTA FE NM
87592-8220
US

V. Phone/Fax

Practice location:
  • Phone: 505-994-9178
  • Fax: 505-896-0478
Mailing address:
  • Phone: 505-471-5006
  • Fax: 877-513-3441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: