Active NPI
Kevin P O'Brien, LCSW, LMFT
- Clinical Social Worker
- Milwaukee, WI
National Provider Identifier
1063429520
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 162
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063429520 | Medicaid | WI |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 162 | WI | MD | Psychologist |
| 691 | WI | MD | Nephrology 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.