MEDICARE: DR. KATHRYN MARY O'BRIEN PSY.D.

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	103TC0700X	Clinical Psychologist	07080	MD

General Provider Information

NPI Number	:	1083289938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHRYN MARY O'BRIEN PSY.D.

Provider Business Mailing Address
First Line	:	3400 SARATOGA AVE
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21403-4929
Country	:	US
Telephone Number	:	443-994-7427
Fax Number	:

Provider Business Practice Location Address
First Line	:	166 DEFENSE HWY
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-8919
Country	:	US
Telephone Number	:	410-684-3806
Fax Number	:

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

Provider Enumeration Date	:	05/24/2021
Last Update Date	:	07/09/2024

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