Provider Demographics
NPI:1538329685
Name:O'BRIEN, LAURA BETH (SCD)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:BETH
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:SCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVE # LO-367
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-3613
Mailing Address - Fax:617-730-0320
Practice Address - Street 1:300 LONGWOOD AVE # LO-367
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-3613
Practice Address - Fax:617-730-0320
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA883231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist