Provider Demographics
NPI:1700260411
Name:O'BRIEN, JESSICA MARIE (LLMSW)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:MARIE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 E JEFFERSON AVE
Mailing Address - Street 2:APT. 24-11
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-4188
Mailing Address - Country:US
Mailing Address - Phone:517-902-7948
Mailing Address - Fax:
Practice Address - Street 1:9000 E JEFFERSON AVE
Practice Address - Street 2:APT. 24-11
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-4188
Practice Address - Country:US
Practice Address - Phone:517-902-7948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010921191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical