Provider Demographics
NPI:1578893285
Name:O'BRIEN, JESSICA CARTER (MA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:CARTER
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11247 SAN JOSE BLVD APT 508
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-7262
Mailing Address - Country:US
Mailing Address - Phone:904-349-1710
Mailing Address - Fax:
Practice Address - Street 1:5776 SAINT AUGUSTINE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8030
Practice Address - Country:US
Practice Address - Phone:904-448-4700
Practice Address - Fax:904-448-4717
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 7040101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health