Provider Demographics
NPI:1629591110
Name:O'BRIEN, JUDITH MERCEDES
Entity Type:Individual
Prefix:PROF
First Name:JUDITH
Middle Name:MERCEDES
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 RODNEY ST
Mailing Address - Street 2:
Mailing Address - City:S SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-1355
Mailing Address - Country:US
Mailing Address - Phone:631-476-1433
Mailing Address - Fax:
Practice Address - Street 1:4 RODNEY ST
Practice Address - Street 2:
Practice Address - City:S SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11720-1355
Practice Address - Country:US
Practice Address - Phone:631-476-1433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist