Healthcare Provider Details

I. General information

NPI: 1265649917
Provider Name (Legal Business Name): KATHRYN OBRIEN MA, LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E 89TH ST APT 12M
NEW YORK NY
10128-6795
US

IV. Provider business mailing address

400 E 89TH ST APT 12M
NEW YORK NY
10128-6795
US

V. Phone/Fax

Practice location:
  • Phone: 917-658-1349
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number000525
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: