Active NPI
Kimberly Obrien, PHD, LICSW
- Clinical Social Worker
- Walpole, MA
National Provider Identifier
1275694309
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 114403
- Practice address
- 12 Red Gate Rd
Walpole, MA 02081-3785 - Phone
- (781) 696-6779
- NPI assigned
- Dec 13, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 114403 | MA | Primary |
| Mental Health Counselor | 101YM0800X |
Addresses
Primary practice location
12 Red Gate Rd
Walpole, MA 02081-3785
Mailing address
12 Red Gate Rd
Walpole, MA 02081-3785
Phone (781) 696-6779
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 042611055 | Other | MA | TAX ID |
| 703136 | Other | MA | TUFTS |
| M18633 | Other | MA | BCBC |
| NP01332 | Other | MA | BMC |
| 1004745 | Other | MA | NHP |
| 1303287 | Other | MA | MBHP |
| 1303287 | Medicaid | MA |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 114403 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707955200000",
"number": "1275694309",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 RED GATE RD",
"city": "WALPOLE",
"state": "MA",
"postal_code": "020813785",
"telephone_number": "781-696-6779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 RED GATE RD",
"city": "WALPOLE",
"state": "MA",
"postal_code": "020813785",
"telephone_number": "781-696-6779"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OBRIEN",
"first_name": "KIMBERLY",
"credential": "PHD, LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-13",
"last_updated": "2024-02-15",
"certification_date": "2024-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "114403",
"primary": true
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "042611055",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS",
"identifier": "703136",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBC",
"identifier": "M18633",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BMC",
"identifier": "NP01332",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NHP",
"identifier": "1004745",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MBHP",
"identifier": "1303287",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1303287",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Walpole, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.