Provider Demographics
NPI:1891007217
Name:O'BRIEN, SUSAN (CASAC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 WINTON RD S
Mailing Address - Street 2:CROSSBRIDGE OFFICE PARK BLDG 2
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3970
Mailing Address - Country:US
Mailing Address - Phone:585-272-8330
Mailing Address - Fax:
Practice Address - Street 1:2000 WINTON RD S
Practice Address - Street 2:CROSSBRIDGE OFFICE PARK BLDG 2
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3970
Practice Address - Country:US
Practice Address - Phone:585-272-8330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)