Provider Demographics
NPI:1629308507
Name:O'BRIEN VEARA, ERIN MAUREEN (PHD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MAUREEN
Last Name:O'BRIEN VEARA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 MARKET ST STE 670
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3309
Mailing Address - Country:US
Mailing Address - Phone:610-453-7463
Mailing Address - Fax:
Practice Address - Street 1:3535 MARKET ST STE 670
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3309
Practice Address - Country:US
Practice Address - Phone:610-453-7463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01161103TC0700X
NJ35SI00557800103TC0700X
PAPS018052103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ35SI00557800OtherPROFESSIONAL LICENSE
PAPS018052OtherPROFESSIONAL LICENSE
RIPS01161OtherPROFESSIONAL LICENSE