MEDICARE: MR. DENNIS KELLY O'BRIEN LCSW, CADC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1760026231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DENNIS KELLY O'BRIEN LCSW, CADC

Provider Business Mailing Address
First Line	:	3450 OAKTON ST STE 300
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-2951
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7433 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-1619
Country	:	US
Telephone Number	:	773-338-8778
Fax Number	:

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

Provider Enumeration Date	:	10/29/2019
Last Update Date	:	10/29/2019

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