Provider Demographics
NPI:1821158619
Name:O'DONNELL, RACHAEL ANN (LCSW, LADC)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:ANN
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:LCSW, LADC
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:ANN
Other - Last Name:HOWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, LADC
Mailing Address - Street 1:88 STATE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1015
Mailing Address - Country:US
Mailing Address - Phone:207-671-7414
Mailing Address - Fax:
Practice Address - Street 1:510 MAIN ST STE 112
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1339
Practice Address - Country:US
Practice Address - Phone:207-939-3295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4075101YA0400X
MELC116621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)