Provider Demographics
NPI:1396802369
Name:O'BRIEN, KEVIN P (PHD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:P
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9832 N HAYDEN RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-1298
Mailing Address - Country:US
Mailing Address - Phone:480-945-3475
Mailing Address - Fax:480-922-5569
Practice Address - Street 1:9832 N HAYDEN RD
Practice Address - Street 2:SUITE 106
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-1298
Practice Address - Country:US
Practice Address - Phone:480-945-3475
Practice Address - Fax:480-922-5569
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1398103G00000X, 103TA0700X, 103T00000X, 103TB0200X, 103TF0200X, 103TP2701X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ60230Medicare PIN
AZR09437Medicare UPIN