Provider Demographics
NPI:1154454114
Name:O'BRIEN, WAYNE DENNIS (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:DENNIS
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8510 SPRINGVALE RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4313
Mailing Address - Country:US
Mailing Address - Phone:301-585-7456
Mailing Address - Fax:
Practice Address - Street 1:8811 COLESVILLE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4343
Practice Address - Country:US
Practice Address - Phone:301-608-3764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD058771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD490468Medicare ID - Type Unspecified