Provider Demographics
NPI:1467552083
Name:O'BRIEN, SUSAN MARGARET (LICSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARGARET
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 STONYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-6802
Mailing Address - Country:US
Mailing Address - Phone:617-645-0973
Mailing Address - Fax:
Practice Address - Street 1:20 TREMONT ST
Practice Address - Street 2:SUITE 28
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-5310
Practice Address - Country:US
Practice Address - Phone:617-645-0973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1121021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA495332OtherTUFTS HEALTH PLAN
MA1467552083OtherMEDICARE PART B
MAP08630OtherBLUE CROSS
MA1070420OtherNEIGHBORHOOD HEALTH PLAN