Individual provider Active NPI

Kevin P O'Brien, LCSW, LMFT

  • Clinical Social Worker
  • Milwaukee, WI
National Provider Identifier
1063429520
Registry record updated Mar 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
162 Issued in WI
Practice address
620 S 76TH St
Milwaukee, WI 53214-1599
Phone
(414) 453-1400
Fax
(414) 453-2538
NPI assigned
Aug 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 691 WI
Clinical Social Worker 1041C0700X 162 WI Primary

Addresses

Primary practice location

620 S 76TH St
Milwaukee, WI 53214-1599

Mailing address

9000 W Wisconsin Ave # Ms 958
Milwaukee, WI 53226-4874
Phone (414) 266-7615

Other identifiers 1

IdentifierTypeStateIssuer
1063429520MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
162WIMDPsychologist
691WIMDNephrology Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584057600000",
    "number": "1063429520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE # MS 958",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-7615",
            "fax_number": "414-266-6238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 S 76TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532141599",
            "telephone_number": "414-453-1400",
            "fax_number": "414-453-2538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'BRIEN",
        "first_name": "KEVIN",
        "middle_name": "P",
        "credential": "LCSW, LMFT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2020-03-13",
        "certification_date": "2020-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WI",
            "license": "691",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "162",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063429520",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.