Healthcare Provider Details

I. General information

NPI: 1740755495
Provider Name (Legal Business Name): PAUL FRANCIS OBRIEN MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 ALLEN ST
RUTLAND VT
05701-4570
US

IV. Provider business mailing address

215 STRATTON RD
RUTLAND VT
05701-4621
US

V. Phone/Fax

Practice location:
  • Phone: 802-773-3386
  • Fax:
Mailing address:
  • Phone: 802-773-3386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: