Provider Demographics
NPI:1003852229
Name:OBRIEN, CAROL ANN (MSW LICSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 13TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2614
Mailing Address - Country:US
Mailing Address - Phone:320-252-5010
Mailing Address - Fax:320-203-1855
Practice Address - Street 1:308 12TH AVE S
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-2321
Practice Address - Country:US
Practice Address - Phone:763-682-4400
Practice Address - Fax:763-682-1353
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5992104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
101949OtherOPTUM
MN762672000Medicaid
151284C851OtherUCARE
6250430OtherMEDICA
HP32385OtherHEALTH PARTNERS
73Q840BOtherBCBS
922241025900OtherPREFERRED ONE
73Q840BOtherBCBS