Healthcare Provider Details

I. General information

NPI: 1578350088
Provider Name (Legal Business Name): VERONICA O'BRIEN MA, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MACCORKLE AVE SE
CHARLESTON WV
25304-1227
US

IV. Provider business mailing address

3301 VIRGINIA AVE SE
CHARLESTON WV
25304-1306
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-1000
  • Fax:
Mailing address:
  • Phone: 716-545-8472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: