Healthcare Provider Details

I. General information

NPI: 1962061366
Provider Name (Legal Business Name): BRENNA SHAE O'BRIEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 DIVISION ST
NASHVILLE TN
37203-4000
US

IV. Provider business mailing address

5415 KENTUCKY AVE
NASHVILLE TN
37209-2010
US

V. Phone/Fax

Practice location:
  • Phone: 615-274-8400
  • Fax:
Mailing address:
  • Phone: 615-948-7522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6351
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: