Provider Demographics
NPI:1861179798
Name:O'BRIEN, COLLEEN (LISW)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:HESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:635 MALLARD CROSSING WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-7030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:540 OFFICENTER PL STE 180
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-5321
Practice Address - Country:US
Practice Address - Phone:888-336-1772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.23045681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical