Respectfully submitted,
MM/DD/YYYY
_________________________________________________ ________________
Timothy J. O’Brien Psy.D. CADC Date
Licensed Psychologist/Licensed Clinical Psychologist
Psytegrity, LLC: 235 S. Maitland Ave., Suite 114 – Maitland, Florida 32751
Examiner Professional Credentials:
State & License(s) #s: Illinois #071010066; Indiana #20043234A
PSYPACT Mobility Program #5846 E. Passport & Interjurisdictional Practice Certificate (IPC);
Association for State and Provincial Psychology Boards (ASPPB)
Certified Alcohol and Drug Counselor #30165; Illinois Certification Board