| Doctor Name: | MS. MARY GRACE OBRIEN |
| NPI Number: | 1780910349 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | N.P. |
| License Number: | F400751 |
| Business Practice Address: | 3651 Hill Blvd Jefferson Valley, NY - 105351501 |
| Business Phone Number: | 9143842075 |
| Business Fax Number: | 9142435895 |
| Mailing Address: | 3651 Hill Blvd, JEFFERSON VALLEY |
| State: | NY |
| Postal Code: | 105351501 |
| Phone Number: | 9143842075 |
| Fax Number: | 9142435895 |
| NPI Enumeration Date: | 11/02/2009 |
| NPI Last Update Date: | 11/02/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | F400751 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |