Healthcare Provider Details

I. General information

NPI: 1225235559
Provider Name (Legal Business Name): AMY TERESE OBRIEN MSED, TVI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 JUSTINE CT
RENSSELAER NY
12144-9666
US

IV. Provider business mailing address

28 JUSTINE CT
RENSSELAER NY
12144-3456
US

V. Phone/Fax

Practice location:
  • Phone: 518-261-1990
  • Fax:
Mailing address:
  • Phone: 518-261-1990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number000875
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: