Provider Demographics
NPI:1932341989
Name:ODONNELL, KATHLEEN M (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:ODONNELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-3138
Mailing Address - Country:US
Mailing Address - Phone:203-217-1840
Mailing Address - Fax:
Practice Address - Street 1:115 MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:CT
Practice Address - Zip Code:06483-3138
Practice Address - Country:US
Practice Address - Phone:203-573-6103
Practice Address - Fax:203-573-7240
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0069951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical