MEDICARE: DR. TIMOTHY J O'BRIEN PSYD

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	071.010066	IL

General Provider Information

NPI Number	:	1801449681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY J O'BRIEN PSYD

Provider Business Mailing Address
First Line	:	2265 W 113TH PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-4104
Country	:	US
Telephone Number	:	773-683-3500
Fax Number	:

Provider Business Practice Location Address
First Line	:	2265 W 113TH PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-4104
Country	:	US
Telephone Number	:	773-683-3500
Fax Number	:

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

Provider Enumeration Date	:	07/19/2019
Last Update Date	:	01/08/2025

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