1770622987 NPI number — MS. DEBRA ODONNELL LCSW

Table of content: MS. DEBRA ODONNELL LCSW (NPI 1770622987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770622987 NPI number — MS. DEBRA ODONNELL LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ODONNELL
Provider First Name:
DEBRA
Provider Middle Name:
Provider Name Prefix Text:
MS.
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770622987
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
73 BEACON HILL ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARDSLEY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-693-7508
Provider Business Mailing Address Fax Number:
914-693-7508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
765 N BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 16D
Provider Business Practice Location Address City Name:
HASTINGS ON HUDSON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-714-8030
Provider Business Practice Location Address Fax Number:
914-693-7508
Provider Enumeration Date:
02/05/2007

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:  R0287471 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 184784P . This is a "HIPPRIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 21476 . This is a "CIGNA EL" identifier . This identifiers is of the category "OTHER".
  • Identifier: P454057 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 179353 . This is a "MHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: R028747 . This is a "VYTRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: D0N037910 . This is a "MED NY EL" identifier . This identifiers is of the category "OTHER".




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