Provider Demographics
NPI:1124334073
Name:O'BRIEN, KELLY (PHD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7910 WOODMONT AVE STE 1101
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-7059
Mailing Address - Country:US
Mailing Address - Phone:301-785-5097
Mailing Address - Fax:
Practice Address - Street 1:7910 WOODMONT AVE STE 1101
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-7059
Practice Address - Country:US
Practice Address - Phone:301-785-5097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-28
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04860103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical