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General NPI Number Information
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NPI Number | 1619171717
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Entity Type | Individual
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Provider Name | MR. JOHN JOSEPH O'BRIEN JR.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 3 CAPITOL HL STE 206
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City | PROVIDENCE
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State | RI
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Zip | 02908-5034
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Country | US
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Telephone | 401-222-2595
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Fax | 401-222-2456
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Provider Business Mailing Address
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Address Line | 3 CAPITOL HL STE 206
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City | PROVIDENCE
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State | RI
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Zip | 02908-5034
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Country | US
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Telephone | 401-222-2595
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Fax | 401-222-2456
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | ELT-0070
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License Number State | RI
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