Provider Demographics
NPI:1730583105
Name:O'BRIEN, CATHERINE DIANE (LICSW)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:DIANE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 784
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-0784
Mailing Address - Country:US
Mailing Address - Phone:541-519-8610
Mailing Address - Fax:
Practice Address - Street 1:2101 MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-2677
Practice Address - Country:US
Practice Address - Phone:541-519-8610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL6794101YM0800X
WALW 604535301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical