Provider Demographics
NPI:1639324460
Name:O'BRIEN, DENISE PARTICIA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:PARTICIA
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8050 189TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11423-1035
Mailing Address - Country:US
Mailing Address - Phone:718-464-3279
Mailing Address - Fax:
Practice Address - Street 1:8050 189TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11423-1035
Practice Address - Country:US
Practice Address - Phone:718-464-3279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000311235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist