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General NPI Number Information
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NPI Number | 1841392719
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Entity Type | Individual
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Provider Name | KEVIN O'BRIEN ACSW-R
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Gender | Male
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 08/05/2013
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Provider Practice Location Address
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Address Line | 3831 MAIN ST
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City | WARRENSBURG
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State | NY
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Zip | 12885-1400
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Country | US
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Telephone | 518-623-2144
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Fax | 360-532-2014
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Provider Business Mailing Address
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Address Line | 3831 MAIN ST
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City | WARRENSBURG
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State | NY
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Zip | 12885-1400
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Country | US
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Telephone | 518-623-2144
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Fax | 518-745-5383
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | PRO25093-1
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License Number State | NY
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