Provider Demographics
NPI:1265736235
Name:O'BRIEN, JENNIFER L (MA, LAPC, ICAADC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MA, LAPC, ICAADC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:WARNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CAADC, DEI
Mailing Address - Street 1:4001 STONEWOOD DR STE 110
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8398
Mailing Address - Country:US
Mailing Address - Phone:724-747-1690
Mailing Address - Fax:
Practice Address - Street 1:4001 STONEWOOD DR STE 110
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8398
Practice Address - Country:US
Practice Address - Phone:724-747-1690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 106S00000X, 101YM0800X
PAAPC000159101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1265736235Medicaid
PA1265736235OtherMEDICAID