Provider Demographics
NPI:1316410921
Name:O'DELL, KAYLA CHRISTINA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:CHRISTINA
Last Name:O'DELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 RIVER STREET SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2268
Mailing Address - Country:US
Mailing Address - Phone:607-441-5055
Mailing Address - Fax:
Practice Address - Street 1:297 RIVER STREET SERVICE RD
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2268
Practice Address - Country:US
Practice Address - Phone:607-441-5055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105449104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker