Provider Demographics
NPI:1245085729
Name:O'BRIEN, MOIRA (MSW, APSW)
Entity type:Individual
Prefix:
First Name:MOIRA
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MSW, APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6207 PHEASANT RUN
Mailing Address - Street 2:
Mailing Address - City:MCFARLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53558-9123
Mailing Address - Country:US
Mailing Address - Phone:254-493-0857
Mailing Address - Fax:
Practice Address - Street 1:3185 DEER POINT DR STE A
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-3773
Practice Address - Country:US
Practice Address - Phone:608-873-7838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI134505-1211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical