Provider Demographics
NPI:1770853830
Name:O'DELL, DAWN ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:ELIZABETH
Last Name:O'DELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 NORTHGATE
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-5715
Mailing Address - Country:US
Mailing Address - Phone:845-798-1097
Mailing Address - Fax:845-651-5073
Practice Address - Street 1:20 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-2216
Practice Address - Country:US
Practice Address - Phone:845-783-7372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0731611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical