Provider Demographics
NPI:1013775402
Name:O'DONNELL, KATE IRENE (LMSW)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:IRENE
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12914 CHERRY POINT DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TX
Mailing Address - Zip Code:77535-5657
Mailing Address - Country:US
Mailing Address - Phone:610-314-8111
Mailing Address - Fax:
Practice Address - Street 1:12914 CHERRY POINT DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TX
Practice Address - Zip Code:77535-5657
Practice Address - Country:US
Practice Address - Phone:610-314-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110799104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker