Doctor Name: | STACEY O'BRIEN |
NPI Number: | 1114059508 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LISW |
License Number: | I-0004534 |
Business Practice Address: | 35010 Chardon Rd Suite 101 Willoughby, OH - 440949010 |
Business Phone Number: | 4406694870 |
Business Fax Number: | |
Mailing Address: | 7990 W River Dr, NOVELTY |
State: | OH |
Postal Code: | 440729733 |
Phone Number: | 4406694870 |
Fax Number: | |
NPI Enumeration Date: | 03/12/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | I-0004534 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |