Provider Demographics
NPI:1932258555
Name:O'BRIEN, MELANIE JILL
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:JILL
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4308 HANOVER PARK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-8602
Mailing Address - Country:US
Mailing Address - Phone:904-465-1049
Mailing Address - Fax:904-438-5423
Practice Address - Street 1:4308 HANOVER PARK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-8602
Practice Address - Country:US
Practice Address - Phone:904-465-1049
Practice Address - Fax:904-438-5423
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL812284900Medicaid
FL766065100Medicaid