Provider Demographics
NPI:1841392719
Name:O'BRIEN, KEVIN (ACSW-R)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:ACSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3831 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12885-1400
Mailing Address - Country:US
Mailing Address - Phone:518-623-2144
Mailing Address - Fax:518-745-5383
Practice Address - Street 1:3831 MAIN ST
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:NY
Practice Address - Zip Code:12885-1400
Practice Address - Country:US
Practice Address - Phone:518-623-2144
Practice Address - Fax:360-532-2014
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO25093-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY61420OtherMOHAWK VALLEY PHYSICIANS
NYU87066OtherAMERIHEALTH
NYN004AOtherEMPIRE BCBS
NY000471308002OtherBLUE SHIELD NENY
NY134173OtherVALUE OPTIONS
NYA935909OtherCAPITAL DISTRICT PHYSICIA
NYN004AOtherEMPIRE BCBS