Provider Demographics
NPI:1306914221
Name:O'BRIEN, DENNIS (PSYD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 COLUMBINE RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-1719
Mailing Address - Country:US
Mailing Address - Phone:617-698-5714
Mailing Address - Fax:
Practice Address - Street 1:9 COLUMBINE RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-1719
Practice Address - Country:US
Practice Address - Phone:617-698-5714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3223103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical