Provider Demographics
NPI:1114060373
Name:O'DONNELL, ROSANNA L (MA)
Entity Type:Individual
Prefix:MRS
First Name:ROSANNA
Middle Name:L
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1843 JURGENSEN DR
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-7513
Mailing Address - Country:US
Mailing Address - Phone:209-385-3621
Mailing Address - Fax:
Practice Address - Street 1:1471 B ST STE N
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:CA
Practice Address - Zip Code:95334-1426
Practice Address - Country:US
Practice Address - Phone:209-394-4032
Practice Address - Fax:209-394-4211
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 47912101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor