Provider Demographics
NPI:1649885617
Name:O'DONNELL, ADRIAN JOHN (MA, LMFT)
Entity type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:JOHN
Last Name:O'DONNELL
Suffix:
Gender:
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 HANFORD LN
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-4510
Mailing Address - Country:US
Mailing Address - Phone:917-359-5915
Mailing Address - Fax:
Practice Address - Street 1:17 HANFORD LN
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-4510
Practice Address - Country:US
Practice Address - Phone:323-508-3294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT120650106H00000X
FLTPMF620106H00000X
CT3508106H00000X
NJ37FI00241800106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist