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General NPI Number Information
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NPI Number | 1497617260
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Entity Type | Individual
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Provider Name | MAYA ELROSE DURFEE O'BRIEN
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Gender | Female
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 2301 W BRADLEY AVE STE 2
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City | CHAMPAIGN
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State | IL
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Zip | 61821-1814
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Country | US
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Telephone | 217-800-5210
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Fax |
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Provider Business Mailing Address
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Address Line | 204 S CHICAGO AVE
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City | BISMARCK
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State | IL
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Zip | 61814-5175
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Country | US
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Telephone |
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Fax |
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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 | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 149030448
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 149030448
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License Number State | IL
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