Provider Demographics
NPI:1376387324
Name:ODEN, CIELITA L (LICSW)
Entity type:Individual
Prefix:
First Name:CIELITA
Middle Name:L
Last Name:ODEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 AMERICANA DR
Mailing Address - Street 2:
Mailing Address - City:ODENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35120-3834
Mailing Address - Country:US
Mailing Address - Phone:205-706-1764
Mailing Address - Fax:
Practice Address - Street 1:90 AMERICANA DR
Practice Address - Street 2:
Practice Address - City:ODENVILLE
Practice Address - State:AL
Practice Address - Zip Code:35120-3834
Practice Address - Country:US
Practice Address - Phone:205-706-1764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5764C225XM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health