Provider Demographics
NPI:1801030416
Name:O'BRIEN, PATRICIA AXSOM (MDIV, LICSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:AXSOM
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MDIV, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 70
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01936
Mailing Address - Country:US
Mailing Address - Phone:978-309-9660
Mailing Address - Fax:
Practice Address - Street 1:639 BAY RD
Practice Address - Street 2:
Practice Address - City:SOUTH HAMILTON
Practice Address - State:MA
Practice Address - Zip Code:01982-1006
Practice Address - Country:US
Practice Address - Phone:978-309-9660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX357381041C0700X
MA10239751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical