1467552083 NPI number — SUSAN MARGARET O'BRIEN LICSW

Table of content: SUSAN MARGARET O'BRIEN LICSW (NPI 1467552083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467552083 NPI number — SUSAN MARGARET O'BRIEN LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'BRIEN
Provider First Name:
SUSAN
Provider Middle Name:
MARGARET
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

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 Information

NPI Number:
1467552083
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 STONYBROOK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARSHFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02050-6802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-645-0973
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 TREMONT ST
Provider Second Line Business Practice Location Address:
SUITE 28
Provider Business Practice Location Address City Name:
DUXBURY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02332-5310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-645-0973
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  112102 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 495332 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1467552083 . This is a "MEDICARE PART B" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P08630 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1070420 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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