Healthcare Provider Details

I. General information

NPI: 1720752397
Provider Name (Legal Business Name): CRAIG PETER OBRIEN MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 STEM LN
STONY BROOK NY
11790-3381
US

IV. Provider business mailing address

7 STEM LN
STONY BROOK NY
11790-3381
US

V. Phone/Fax

Practice location:
  • Phone: 631-338-3702
  • Fax:
Mailing address:
  • Phone: 631-338-3702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: