Provider Demographics
NPI:1033557137
Name:O'DONNELL, JASON (LCSW)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 AVENUE AT THE CMN
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4807
Mailing Address - Country:US
Mailing Address - Phone:732-943-1326
Mailing Address - Fax:732-865-7190
Practice Address - Street 1:39 AVENUE AT THE CMN
Practice Address - Street 2:SUITE 106
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4807
Practice Address - Country:US
Practice Address - Phone:732-943-1326
Practice Address - Fax:732-865-7190
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2015-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055418001041C0700X
CA281271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical