Provider Demographics
NPI:1679334981
Name:O'DELL, JOANNE H (LAC)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:H
Last Name:O'DELL
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:H
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:402 AURORA AVE.
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:95 N STATE RT 17 STE 100
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2648
Practice Address - Country:US
Practice Address - Phone:551-368-0304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00850600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37AC00850600OtherLICENSED ASSOCIATE COUNSELOR LICENSE NUMBER