Healthcare Provider Details

I. General information

NPI: 1124565189
Provider Name (Legal Business Name): CLARA ELOISE O'BRIEN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2017
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 N 115TH ST
SEATTLE WA
98133-8401
US

IV. Provider business mailing address

PO BOX 50095
SEATTLE WA
98145-5095
US

V. Phone/Fax

Practice location:
  • Phone: 206-364-0500
  • Fax:
Mailing address:
  • Phone: 206-520-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPSYC.PY.70046950
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: