Healthcare Provider Details

I. General information

NPI: 1952692436
Provider Name (Legal Business Name): SEAN PATRICK O'BRIEN MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 01/06/2024
Certification Date: 01/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S FREYA ST STE 314B
SPOKANE WA
99202-6206
US

IV. Provider business mailing address

718 E GRETA AVE
SPOKANE WA
99208-5246
US

V. Phone/Fax

Practice location:
  • Phone: 505-255-3161
  • Fax: 833-563-2551
Mailing address:
  • Phone: 509-834-9635
  • Fax: 833-563-2551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60593012
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberCGG0189074
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: