Provider Demographics
NPI:1639188451
Name:OBRIEN, RAYMOND W (PHD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:W
Last Name:OBRIEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 N COSBY AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2378
Mailing Address - Country:US
Mailing Address - Phone:816-746-4743
Mailing Address - Fax:816-746-4753
Practice Address - Street 1:6405 N COSBY AVE
Practice Address - Street 2:STE 203
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-2378
Practice Address - Country:US
Practice Address - Phone:816-746-4743
Practice Address - Fax:816-746-4753
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01239103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO498474618Medicaid
MO0000546BMedicare ID - Type Unspecified