Provider Demographics
NPI:1871845339
Name:BATES, ODESSA
Entity Type:Individual
Prefix:
First Name:ODESSA
Middle Name:
Last Name:BATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 ROCKLAND DR
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-8418
Mailing Address - Country:US
Mailing Address - Phone:413-642-1165
Mailing Address - Fax:
Practice Address - Street 1:27 ROCKLAND DR
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-8418
Practice Address - Country:US
Practice Address - Phone:413-642-1165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA105374J00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1308785Medicaid
MA110027991Medicaid
MAM18684OtherBLUE CROSS BLUE SHEILD
MA1306461Medicaid
MA22220002001OtherBLUE CROSS OF MASS
MAM18684OtherBLUE CROSS BLUE SHEILD