Provider Demographics
NPI:1083293898
Name:OBRIEN, NICOLE (MFT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 E 52ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-6201
Mailing Address - Country:US
Mailing Address - Phone:212-712-8800
Mailing Address - Fax:
Practice Address - Street 1:130 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3805
Practice Address - Country:US
Practice Address - Phone:516-780-5369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist