Provider Demographics
NPI:1902284458
Name:O'BRIEN, MARYELLEN (LMHC)
Entity Type:Individual
Prefix:
First Name:MARYELLEN
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MARYELLEN
Other - Middle Name:
Other - Last Name:GARVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:WOT 2ND FL, SUITE C203
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2038
Mailing Address - Country:US
Mailing Address - Phone:508-368-5532
Mailing Address - Fax:508-853-4354
Practice Address - Street 1:630 PLANTATION ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2038
Practice Address - Country:US
Practice Address - Phone:508-853-2854
Practice Address - Fax:508-853-4354
Is Sole Proprietor?:No
Enumeration Date:2015-05-15
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1196101YM0800X
MA611101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)