Provider Demographics
NPI:1265720759
Name:STONE O'BRIEN, JAMIE (PSYD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:STONE O'BRIEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 N HALSTED ST
Mailing Address - Street 2:SUITE 504
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-2605
Mailing Address - Country:US
Mailing Address - Phone:847-686-0090
Mailing Address - Fax:847-686-0090
Practice Address - Street 1:1460 N HALSTED ST
Practice Address - Street 2:SUITE 504
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2605
Practice Address - Country:US
Practice Address - Phone:847-686-0090
Practice Address - Fax:847-686-0090
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008769103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist