Provider Demographics
NPI:1831428945
Name:O'BRIEN, JAMES GERARD (BCABA)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:GERARD
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5614 NETHERLAND AVE
Mailing Address - Street 2:APT. 5G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-1707
Mailing Address - Country:US
Mailing Address - Phone:917-734-8305
Mailing Address - Fax:
Practice Address - Street 1:277 MAIN ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:SOUTH RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08882-2042
Practice Address - Country:US
Practice Address - Phone:732-254-0300
Practice Address - Fax:732-254-3131
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst