Provider Demographics
NPI:1578960696
Name:O'BRIEN, TERESA MARIE (LMHC, EDPSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:LMHC, EDPSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3960
Mailing Address - Country:US
Mailing Address - Phone:508-823-5400
Mailing Address - Fax:508-828-9146
Practice Address - Street 1:1 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3960
Practice Address - Country:US
Practice Address - Phone:508-823-5400
Practice Address - Fax:508-828-9146
Is Sole Proprietor?:No
Enumeration Date:2014-12-04
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4868101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health