Provider Demographics
NPI:1255602389
Name:DR KEVIN O'BRIEN, PHD
Entity type:Organization
Organization Name:DR KEVIN O'BRIEN, PHD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/ PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCD, LCSW
Authorized Official - Phone:212-539-3710
Mailing Address - Street 1:24 E 12TH ST
Mailing Address - Street 2:SUITE 603
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4513
Mailing Address - Country:US
Mailing Address - Phone:212-539-3710
Mailing Address - Fax:
Practice Address - Street 1:24 E 12TH ST
Practice Address - Street 2:SUITE 603
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4513
Practice Address - Country:US
Practice Address - Phone:212-539-3710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR05172911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN4H161Medicare Oscar/Certification