Provider Demographics
NPI:1861801227
Name:OBRIEN, KATHLEEN (LMSW; CASACT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:LMSW; CASACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 RUTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-5328
Mailing Address - Country:US
Mailing Address - Phone:845-342-4966
Mailing Address - Fax:
Practice Address - Street 1:10 KAYLEEN DR
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-7030
Practice Address - Country:US
Practice Address - Phone:845-565-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-10
Last Update Date:2014-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30411101YA0400X
NY72-079068101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)