Healthcare Provider Details

I. General information

NPI: 1326240474
Provider Name (Legal Business Name): ELOISE A OBRIEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 MEYER RD
AMHERST NY
14226-1008
US

IV. Provider business mailing address

135 MEYER RD
AMHERST NY
14226-1008
US

V. Phone/Fax

Practice location:
  • Phone: 716-837-3352
  • Fax: 716-837-3005
Mailing address:
  • Phone: 716-837-3352
  • Fax: 716-837-3005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number009727
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: