Provider Demographics
NPI:1508139619
Name:O'BRIEN, KATHLEEN MARY (BA, MED)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARY
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:BA, MED
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:MARY
Other - Last Name:WHLELAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, MED
Mailing Address - Street 1:30 PRINCE PATH
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563-2467
Mailing Address - Country:US
Mailing Address - Phone:508-431-4812
Mailing Address - Fax:
Practice Address - Street 1:30 PRINCE PATH
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563-2467
Practice Address - Country:US
Practice Address - Phone:508-431-4812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool