Basic Information
| Provider Information | |||||||||
| NPI: | 1689696866 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | O'BRIEN | ||||||||
| FirstName: | EILEEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MCALLISTER | ||||||||
| OtherFirstName: | EILEEN | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 30 STRAWBERRY HILL LN | ||||||||
| Address2: | |||||||||
| City: | WEST NYACK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109941622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453535213 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7701 13TH AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112282413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182321351 | ||||||||
| FaxNumber: | 7188375676 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 000684 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.