Provider Demographics
NPI:1356534002
Name:OBRIEN, EDYLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:EDYLE
Middle Name:
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:EDYLE
Other - Middle Name:
Other - Last Name:COPILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:16 DIANE DRIVE
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937
Mailing Address - Country:US
Mailing Address - Phone:631-786-3650
Mailing Address - Fax:
Practice Address - Street 1:16 DIANE DRIVE
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937
Practice Address - Country:US
Practice Address - Phone:631-786-3650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047821 1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNH6191Medicare UPIN