Provider Demographics
NPI:1275140907
Name:O'BRIEN, CAMILLE JOYCE (LCSW)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:JOYCE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:JOYCE
Other - Last Name:CALAME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:400 CRAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2959
Mailing Address - Country:US
Mailing Address - Phone:908-247-9671
Mailing Address - Fax:
Practice Address - Street 1:400 CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-2959
Practice Address - Country:US
Practice Address - Phone:908-247-9671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-27
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ6212141041S0200X
NJ44SC054666001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool