Provider Demographics
NPI:1689190860
Name:O'BRIEN, JACQUELINE MARY
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:MARY
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 1:50 VANTAGE POINT DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1180
Mailing Address - Country:US
Mailing Address - Phone:585-352-7775
Mailing Address - Fax:585-352-7879
Practice Address - Street 1:50 VANTAGE POINT DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1180
Practice Address - Country:US
Practice Address - Phone:585-352-7775
Practice Address - Fax:585-352-7879
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator