Provider Demographics
NPI:1417052374
Name:O'DONNELL, LAURA OLKEN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:OLKEN
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:ELAINE
Other - Last Name:OLKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:33 BROAD COVE
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107
Mailing Address - Country:US
Mailing Address - Phone:207-420-1465
Mailing Address - Fax:207-839-9142
Practice Address - Street 1:33 BROAD COVE ROAD
Practice Address - Street 2:
Practice Address - City:CAPE ELIZABETH
Practice Address - State:ME
Practice Address - Zip Code:04107
Practice Address - Country:US
Practice Address - Phone:207-420-1465
Practice Address - Fax:207-839-9142
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC64901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM7882Medicare UPIN