Provider Demographics
NPI:1861428674
Name:O'BRIEN, SHARON LYNN
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:LYNN
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SHARON
Other - Middle Name:LYNN
Other - Last Name:DELORIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACSW, LCSW
Mailing Address - Street 1:6121 GREEN BAY RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-2926
Mailing Address - Country:US
Mailing Address - Phone:262-652-7222
Mailing Address - Fax:262-652-1734
Practice Address - Street 1:6121 GREEN BAY RD
Practice Address - Street 2:SUITE 220
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-2926
Practice Address - Country:US
Practice Address - Phone:262-652-7222
Practice Address - Fax:262-652-1734
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164 - 123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI354535OtherPHCS
WI39663300Medicaid