Healthcare Provider Details

I. General information

NPI: 1851707582
Provider Name (Legal Business Name): WILLIAM OBRIEN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 E 111TH ST APT 608
NEW YORK NY
10029-0249
US

IV. Provider business mailing address

64 E 111TH ST APY 608
NEW YORK NY
10029-0249
US

V. Phone/Fax

Practice location:
  • Phone: 917-587-6711
  • Fax:
Mailing address:
  • Phone: 917-587-6711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number080208
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: