Provider Demographics
NPI:1134799844
Name:ODOM, CLAIRE (LMSW)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:ODOM
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 1:175 GREEN ST UNIT 4
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3716
Mailing Address - Country:US
Mailing Address - Phone:845-532-9460
Mailing Address - Fax:
Practice Address - Street 1:175 GREEN ST UNIT 4
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3716
Practice Address - Country:US
Practice Address - Phone:845-532-9460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-26
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103028104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker