Provider Demographics
NPI:1598483877
Name:O'DELL, PHYLICIA ALEXANDRIA (BSW)
Entity Type:Individual
Prefix:MISS
First Name:PHYLICIA
Middle Name:ALEXANDRIA
Last Name:O'DELL
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 E MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-1400
Mailing Address - Country:US
Mailing Address - Phone:506-755-0556
Mailing Address - Fax:
Practice Address - Street 1:29 E MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-1400
Practice Address - Country:US
Practice Address - Phone:506-755-0556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker