Provider Demographics
NPI:1598835779
Name:O'BRIEN, VIRGINIA CLAIRE (LICSW)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:CLAIRE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 STRATFORD LN
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02675-1545
Mailing Address - Country:US
Mailing Address - Phone:508-362-5339
Mailing Address - Fax:
Practice Address - Street 1:4 STRATFORD LN
Practice Address - Street 2:
Practice Address - City:YARMOUTH PORT
Practice Address - State:MA
Practice Address - Zip Code:02675-1545
Practice Address - Country:US
Practice Address - Phone:508-362-5339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10234971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical