Provider Demographics
NPI:1912733676
Name:OBRIEN DENNIS INITIATIVE
Entity type:Organization
Organization Name:OBRIEN DENNIS INITIATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:O'BRIEN
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:718-869-1862
Mailing Address - Street 1:36 S 15TH AVE # 2
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2814
Mailing Address - Country:US
Mailing Address - Phone:718-869-1862
Mailing Address - Fax:
Practice Address - Street 1:36 S 15TH AVE # 2
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2814
Practice Address - Country:US
Practice Address - Phone:718-869-1862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty