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General NPI Number Information
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NPI Number | 1255602389
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Entity Type | Organization
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Legal Business Name | DR KEVIN O'BRIEN, PHD
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Dates
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Enumeration Date | 01/20/2012
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Last Update Date | 01/23/2012
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Provider Practice Location Address
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Address Line | 24 E 12TH ST SUITE 603
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City | NEW YORK
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State | NY
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Zip | 10003-4513
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Country | US
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Telephone | 212-539-3710
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Fax |
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Provider Business Mailing Address
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Address Line | 24 E 12TH ST SUITE 603
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City | NEW YORK
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State | NY
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Zip | 10003-4513
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Country | US
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Telephone | 212-539-3710
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Fax |
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Authorized Official
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Title or Position | DOCTOR/ PSYCHOTHERAPIST
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Name | DR. KEVIN O'BRIEN
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Credential | PH.D., BCD, LCSW
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Telephone | 212-539-3710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R0517291
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License Number State | NY
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