1417052374 NPI number — MRS. LAURA OLKEN O'DONNELL LCSW

Table of content: MRS. LAURA OLKEN O'DONNELL LCSW (NPI 1417052374)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417052374 NPI number — MRS. LAURA OLKEN O'DONNELL LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'DONNELL
Provider First Name:
LAURA
Provider Middle Name:
OLKEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OLKEN
Provider Other First Name:
LAURA
Provider Other Middle Name:
ELAINE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417052374
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 BROAD COVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAPE ELIZABETH
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-420-1465
Provider Business Mailing Address Fax Number:
207-839-9142

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 BROAD COVE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAPE ELIZABETH
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-420-1465
Provider Business Practice Location Address Fax Number:
207-839-9142
Provider Enumeration Date:
09/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LC6490 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)