Provider Demographics
NPI:1760587893
Name:O'BRIEN, ROSEMARY (MA,LP)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MA,LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6860 SHINGLE CREEK PKWY
Mailing Address - Street 2:SUITE 116
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-1411
Mailing Address - Country:US
Mailing Address - Phone:763-560-4860
Mailing Address - Fax:763-503-1430
Practice Address - Street 1:6860 SHINGLE CREEK PKWY
Practice Address - Street 2:SUITE 116
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-1411
Practice Address - Country:US
Practice Address - Phone:763-560-4860
Practice Address - Fax:763-503-1430
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3923103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist