Provider Demographics
NPI:1891451324
Name:O'BRIEN, ROBERT W (MA CMHC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:W
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:MA CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:568 MORGAN WOOD DR
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-8459
Mailing Address - Country:US
Mailing Address - Phone:407-617-5056
Mailing Address - Fax:
Practice Address - Street 1:1307 S INTERNATIONAL PKWY STE 2051
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1414
Practice Address - Country:US
Practice Address - Phone:321-363-3412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH21055101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty