Provider Demographics
NPI:1114163078
Name:O'BRIEN, KATHRYN JEAN (CAADE, CAADAC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JEAN
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:CAADE, CAADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11600 ELDRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:91342-6506
Mailing Address - Country:US
Mailing Address - Phone:818-636-3000
Mailing Address - Fax:818-896-4232
Practice Address - Street 1:11600 ELDRIDGE AVE
Practice Address - Street 2:
Practice Address - City:LAKE VIEW TERRACE
Practice Address - State:CA
Practice Address - Zip Code:91342-6506
Practice Address - Country:US
Practice Address - Phone:818-636-3000
Practice Address - Fax:818-896-4232
Is Sole Proprietor?:No
Enumeration Date:2008-12-25
Last Update Date:2008-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA020545101YA0400X
CAA8479404101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)