Provider Demographics
NPI:1912093543
Name:ODES, JOAN A (MSW)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:A
Last Name:ODES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 W 23RD ST
Mailing Address - Street 2:APT. 5U
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2407
Mailing Address - Country:US
Mailing Address - Phone:212-243-0377
Mailing Address - Fax:212-243-1691
Practice Address - Street 1:170 W 23RD ST
Practice Address - Street 2:APT. 5U
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2407
Practice Address - Country:US
Practice Address - Phone:212-243-0377
Practice Address - Fax:212-243-1691
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYCSWR0170411041C0700X
NJNJLCSW44SC000308001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNOR991Medicare ID - Type Unspecified
NJ634437Medicare ID - Type Unspecified