Provider Demographics
NPI:1477835650
Name:OBRIEN, MICHAEL P (CASAC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:P
Last Name:OBRIEN
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:18 PLATT ST
Mailing Address - Street 2:APT 5
Mailing Address - City:WALTON
Mailing Address - State:NY
Mailing Address - Zip Code:13856-1353
Mailing Address - Country:US
Mailing Address - Phone:607-206-3287
Mailing Address - Fax:607-865-7659
Practice Address - Street 1:34570 STATE HIGHWAY 10
Practice Address - Street 2:SUITE 5
Practice Address - City:HAMDEN
Practice Address - State:NY
Practice Address - Zip Code:13782-1120
Practice Address - Country:US
Practice Address - Phone:607-865-7656
Practice Address - Fax:607-865-7659
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY24203101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)