Healthcare Provider Details

I. General information

NPI: 1881902195
Provider Name (Legal Business Name): CHRISTINE L OBRIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 ELM ST
GLENS FALLS NY
12801-3549
US

IV. Provider business mailing address

PO BOX 31094
HARTFORD CT
06150-1094
US

V. Phone/Fax

Practice location:
  • Phone: 518-798-5004
  • Fax:
Mailing address:
  • Phone: 518-952-8140
  • Fax: 518-952-8287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: