Provider Demographics
NPI:1184199010
Name:O'BRIEN, MARY JEANETTE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JEANETTE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SOUTH CENTRE AVE.
Mailing Address - Street 2:APT. 1LL
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570
Mailing Address - Country:US
Mailing Address - Phone:516-732-6871
Mailing Address - Fax:
Practice Address - Street 1:CAMPUS MAGNET BUILDING
Practice Address - Street 2:207-01 116TH AVENUE
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411
Practice Address - Country:US
Practice Address - Phone:718-978-1837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0985141041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool