Provider Demographics
NPI:1891190781
Name:ODMARK, ROSEMARY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROSEMARY
Middle Name:
Last Name:ODMARK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ROSEMARY
Other - Middle Name:
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 E GALENA BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-3338
Mailing Address - Country:US
Mailing Address - Phone:855-241-7160
Mailing Address - Fax:954-324-8354
Practice Address - Street 1:105 E GALENA BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-3338
Practice Address - Country:US
Practice Address - Phone:855-241-7160
Practice Address - Fax:954-324-8354
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0067191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical