Provider Demographics
NPI:1508551029
Name:O'BRIEN, EARL DOMINICK JR (MHC)
Entity Type:Individual
Prefix:MR
First Name:EARL
Middle Name:DOMINICK
Last Name:O'BRIEN
Suffix:JR
Gender:M
Credentials:MHC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:18709 LINDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-4025
Mailing Address - Country:US
Mailing Address - Phone:718-500-5549
Mailing Address - Fax:917-725-6210
Practice Address - Street 1:18709 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-4025
Practice Address - Country:US
Practice Address - Phone:718-500-5549
Practice Address - Fax:917-725-6210
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health