Provider Demographics
NPI:1689156143
Name:O'DONNELL, KELLY (LICSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 POWDER HOUSE AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6556
Mailing Address - Country:US
Mailing Address - Phone:978-457-3576
Mailing Address - Fax:
Practice Address - Street 1:25 RAILROAD SQ
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01832-5721
Practice Address - Country:US
Practice Address - Phone:855-816-4777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1195671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical