Provider Demographics
NPI:1841758000
Name:O'BRIEN, MICHELE LEE (STUDENT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:LEE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GAS LIGHT DR APT 9
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-2232
Mailing Address - Country:US
Mailing Address - Phone:781-803-3597
Mailing Address - Fax:
Practice Address - Street 1:541 MAIN ST STE 303
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1845
Practice Address - Country:US
Practice Address - Phone:781-331-7866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health