Provider Demographics
NPI:1831818988
Name:O'DONNELL, KEVIN JOSEPH (RECOVERY COACH)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:JOSEPH
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:RECOVERY COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-3275
Mailing Address - Country:US
Mailing Address - Phone:413-774-6252
Mailing Address - Fax:
Practice Address - Street 1:102 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-3275
Practice Address - Country:US
Practice Address - Phone:413-774-6252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist