Provider Demographics
NPI:1477938215
Name:DEBORAH A ODONNELL, PHD, CLINICAL PSYCHOLOGIST, LLC
Entity Type:Organization
Organization Name:DEBORAH A ODONNELL, PHD, CLINICAL PSYCHOLOGIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:O'DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:240-587-0457
Mailing Address - Street 1:PO BOX 1212
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-1212
Mailing Address - Country:US
Mailing Address - Phone:240-587-0457
Mailing Address - Fax:301-475-8810
Practice Address - Street 1:41660 COURTHOUSE DR # 201C
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-3887
Practice Address - Country:US
Practice Address - Phone:240-587-0457
Practice Address - Fax:301-475-8810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03958103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty