Provider Demographics
NPI:1164759221
Name:O'BRIEN, CHARLES EDWARD
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDWARD
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 SLAB CITY RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLNVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04849-5203
Mailing Address - Country:US
Mailing Address - Phone:207-380-3899
Mailing Address - Fax:
Practice Address - Street 1:16 TANNERY LN
Practice Address - Street 2:SUITE 23
Practice Address - City:CAMDEN
Practice Address - State:ME
Practice Address - Zip Code:04843-1750
Practice Address - Country:US
Practice Address - Phone:207-380-3899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC134161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical