Active NPI
Mary Grace Obrien, N.P.
- Psychiatric/Mental Health Nurse Practitioner
- Jefferson Valley, NY
National Provider Identifier
1780910349
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- F400751
- Practice address
- 3651 Hill Blvd
Jefferson Valley, NY 10535-1501 - Phone
- (914) 384-2075
- Fax
- (914) 243-5895
- NPI assigned
- Nov 2, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | F400751 | NY | Primary |
Addresses
Primary practice location
3651 Hill Blvd
Jefferson Valley, NY 10535-1501
Mailing address
3651 Hill Blvd
Jefferson Valley, NY 10535-1501
Phone (914) 384-2075
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Sep 23, 2021 through Sep 23, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F400751 | NY | MD | Psychiatric/Mental Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1257120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257120000000",
"number": "1780910349",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3651 HILL BLVD",
"city": "JEFFERSON VALLEY",
"state": "NY",
"postal_code": "105351501",
"telephone_number": "914-384-2075",
"fax_number": "914-243-5895"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3651 HILL BLVD",
"city": "JEFFERSON VALLEY",
"state": "NY",
"postal_code": "105351501",
"telephone_number": "914-384-2075",
"fax_number": "914-243-5895"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OBRIEN",
"first_name": "MARY",
"middle_name": "GRACE",
"name_prefix": "Ms.",
"credential": "N.P.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-11-02",
"last_updated": "2009-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "NY",
"license": "F400751",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jefferson Valley, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.