Healthcare Provider Details

I. General information

NPI: 1558690867
Provider Name (Legal Business Name): ERIN O'BRIEN MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 WALNUT ST STE 1004
PHILADELPHIA PA
19107-4719
US

IV. Provider business mailing address

310 S 10TH ST APT. #4A
PHILADELPHIA PA
19107-6135
US

V. Phone/Fax

Practice location:
  • Phone: 215-567-1111
  • Fax:
Mailing address:
  • Phone: 856-981-7015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC005290
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: