Provider Demographics
NPI:1992020283
Name:O'DONNELL, PATRICK BREECE (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:BREECE
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 HABBERTON AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1740
Mailing Address - Country:US
Mailing Address - Phone:847-830-5049
Mailing Address - Fax:
Practice Address - Street 1:2212 HABBERTON AVE
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1740
Practice Address - Country:US
Practice Address - Phone:847-830-5049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0098031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical