1336230986 NPI number — MS. MAUREEN O BRIEN MSSA LICSW

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336230986 NPI number — MS. MAUREEN O BRIEN MSSA LICSW

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

O BRIEN

Provider First Name:

MAUREEN

Provider Middle Name:

Provider Name Prefix Text:

MS.

Provider Name Suffix Text:

Provider Credential Text:

MSSA LICSW

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1336230986

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/31/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 125

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

FITZWILLIAM

Provider Business Mailing Address State Name:

NH

Provider Business Mailing Address Postal Code:

03447

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

603-924-7462

Provider Business Mailing Address Fax Number:

603-924-2138

Provider First Line Business Practice Location Address:

20 GROVE STREET

Provider Second Line Business Practice Location Address:

PETERBOROUGH CLINICAL ASSOCIATES

Provider Business Practice Location Address City Name:

PETERBOROUGH

Provider Business Practice Location Address State Name:

NH

Provider Business Practice Location Address Postal Code:

03458

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

603-924-7462

Provider Business Practice Location Address Fax Number:

603-924-2138

Provider Enumeration Date:

09/27/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 1041C0700X , with the licence number:  240 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 1041C0700X , with the licence number: 1015861 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: NH240 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: P07848 . This is a "BLUE CROSS MA" identifier . This identifiers is of the category "OTHER".
• Identifier: 1039550 . This is a "BEACON HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 80001345 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
• Identifier: NH240 . This is a "NAHGA" identifier . This identifiers is of the category "OTHER".
• Identifier: 006245 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
• Identifier: NH240 . This is a "C B A" identifier . This identifiers is of the category "OTHER".
• Identifier: NH240 . This is a "HEALTH CARE VALUE MANAGEM" identifier . This identifiers is of the category "OTHER".
• Identifier: 1402015Y0NH01 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
• Identifier: 15398 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: NH240 . This is a "BENEFIT PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: NH240 . This is a "PBH" identifier . This identifiers is of the category "OTHER".
• Identifier: NH240 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: NH240 . This is a "UBH" identifier . This identifiers is of the category "OTHER".