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General NPI Number Information
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NPI Number | 1649133711
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Entity Type | Individual
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Provider Name | MARY CHRISTINE O'BRIEN PSYD
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Gender | Female
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 4 SMITH HAVEN MALL
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City | LAKE GROVE
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State | NY
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Zip | 11755-1219
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Country | US
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Telephone | 631-444-8053
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Fax |
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Provider Business Mailing Address
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Address Line | 96 BAY RD
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City | HALESITE
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State | NY
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Zip | 11743-1356
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 027770
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License Number State | NY
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