Provider Demographics
NPI:1770547226
Name:O'BRIEN, LYNN (ACSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:ACSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 E 73RD ST
Mailing Address - Street 2:APT 3D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3882
Mailing Address - Country:US
Mailing Address - Phone:917-225-9207
Mailing Address - Fax:
Practice Address - Street 1:11015 71ST RD
Practice Address - Street 2:SUITE 1 J
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4951
Practice Address - Country:US
Practice Address - Phone:917-225-9207
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR026507-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3457920OtherOXFORD PROVIDER #
NYP3457920OtherOXFORD PROVIDER #