Doctor Name: | JOHN O'BRIEN |
NPI Number: | 1457579427 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LICSW |
License Number: | 14313 |
Business Practice Address: | 2101 Grand Ave Long Lake, MN - 553569705 |
Business Phone Number: | 6122027227 |
Business Fax Number: | |
Mailing Address: | 2101 Grand Ave, LONG LAKE |
State: | MN |
Postal Code: | 553569705 |
Phone Number: | 6122027227 |
Fax Number: | |
NPI Enumeration Date: | 04/23/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 14313 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |