Provider Demographics
NPI:1326240474
Name:OBRIEN, ELOISE A (PHD)
Entity Type:Individual
Prefix:
First Name:ELOISE
Middle Name:A
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 MEYER RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1008
Mailing Address - Country:US
Mailing Address - Phone:716-837-3352
Mailing Address - Fax:716-837-3005
Practice Address - Street 1:135 MEYER RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1008
Practice Address - Country:US
Practice Address - Phone:716-837-3352
Practice Address - Fax:716-837-3005
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009727103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY036141Medicare ID - Type Unspecified