Provider Demographics
NPI:1205145497
Name:O'BRIEN, ELIZABETH CREIGHTON
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CREIGHTON
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:POINT REYES STATION
Mailing Address - State:CA
Mailing Address - Zip Code:94956-0096
Mailing Address - Country:US
Mailing Address - Phone:415-444-6715
Mailing Address - Fax:000-555-5555
Practice Address - Street 1:259 LAUREL STREET
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:CA
Practice Address - Zip Code:94937
Practice Address - Country:US
Practice Address - Phone:415-870-4660
Practice Address - Fax:000-555-5555
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA274291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program