Provider Demographics
NPI:1104989367
Name:O'BRIEN, SARAH D (LICSW, RPT-S)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:D
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:LICSW, RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 S ANGELL ST # 327
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5206
Mailing Address - Country:US
Mailing Address - Phone:401-374-2069
Mailing Address - Fax:
Practice Address - Street 1:291 WATERMAN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5130
Practice Address - Country:US
Practice Address - Phone:401-374-2069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW013211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical