Provider Demographics
NPI:1154605913
Name:O'BRIEN, STEPHEN J (LCSW-R)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:J
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 RICHMOND AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1741
Mailing Address - Country:US
Mailing Address - Phone:167-397-1644
Mailing Address - Fax:
Practice Address - Street 1:428 RICHMOND AVE APT 1
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-1741
Practice Address - Country:US
Practice Address - Phone:163-971-6447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01368923Medicaid