Provider Demographics
NPI:1205837903
Name:O'BRIEN, ROBERT J (MSW, LMSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 STATE ST
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2750
Mailing Address - Country:US
Mailing Address - Phone:231-487-4694
Mailing Address - Fax:231-347-9405
Practice Address - Street 1:3890 CHARLEVOIX AVE
Practice Address - Street 2:SUITE 185
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770
Practice Address - Country:US
Practice Address - Phone:231-487-4694
Practice Address - Fax:231-347-9405
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010576051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008941730OtherBC/BS PROVIDER NUMBER
MI8008941730OtherBC/BS PROVIDER NUMBER