Provider Demographics
NPI:1588834493
Name:O'BRIEN, MARY ELIZABETH (LCPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 LONGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-2320
Mailing Address - Country:US
Mailing Address - Phone:410-956-8434
Mailing Address - Fax:410-956-7686
Practice Address - Street 1:1705 LONGWOOD RD
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-2320
Practice Address - Country:US
Practice Address - Phone:410-303-2982
Practice Address - Fax:410-956-7686
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1003101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD167750100Medicaid