Provider Demographics
NPI:1881947216
Name:O'BRIEN, KEVIN (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 E 12TH ST
Mailing Address - Street 2:SUITE 603
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4513
Mailing Address - Country:US
Mailing Address - Phone:212-539-3710
Mailing Address - Fax:
Practice Address - Street 1:24 E 12TH ST
Practice Address - Street 2:SUITE 603
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4513
Practice Address - Country:US
Practice Address - Phone:212-539-3710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst