Provider Demographics
NPI:1083166458
Name:O'BRIEN, MOLLY LEIGH DIETZLER (LICSW)
Entity Type:Individual
Prefix:MISS
First Name:MOLLY
Middle Name:LEIGH DIETZLER
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1045 WARWICK AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-3665
Mailing Address - Country:US
Mailing Address - Phone:401-406-1205
Mailing Address - Fax:401-270-0660
Practice Address - Street 1:1045 WARWICK AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3665
Practice Address - Country:US
Practice Address - Phone:401-406-1205
Practice Address - Fax:401-270-0660
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW026681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical