MEDICARE: DR. SEAN HYDE O'BRIEN PSY.D., ABPDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	8801	MA

General Provider Information

NPI Number	:	1013286897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN HYDE O'BRIEN PSY.D., ABPDN

Provider Business Mailing Address
First Line	:	2464 MASSACHUSETTS AVE
Second Line	:	SUITE 129
City	:	CAMBRIDGE
State	:	MA
Zip	:	02140-1646
Country	:	US
Telephone Number	:	617-354-5050
Fax Number	:

Provider Business Practice Location Address
First Line	:	2464 MASSACHUSETTS AVE
Second Line	:	SUITE 129
City	:	CAMBRIDGE
State	:	MA
Zip	:	02140-1646
Country	:	US
Telephone Number	:	617-354-5050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2011
Last Update Date	:	12/22/2011

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