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General NPI Number Information
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NPI Number | 1063429520
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Entity Type | Individual
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Provider Name | KEVIN P O'BRIEN LCSW, LMFT
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 03/13/2020
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Provider Practice Location Address
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Address Line | 620 S 76TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53214-1599
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Country | US
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Telephone | 414-453-1400
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Fax | 414-453-2538
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Provider Business Mailing Address
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Address Line | 9000 W WISCONSIN AVE # MS 958
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City | MILWAUKEE
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State | WI
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Zip | 53226-4874
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Country | US
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Telephone | 414-266-7615
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Fax | 414-266-6238
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 691
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 162
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License Number State | WI
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