MEDICARE: AMELIA MCKINNEY-ODASSO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904019896	VA

General Provider Information

NPI Number	:	1962333088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMELIA MCKINNEY-ODASSO

Provider Business Mailing Address
First Line	:	4412 BOXWOOD DR
Second Line	:
City	:	DUMFRIES
State	:	VA
Zip	:	22025-1624
Country	:	US
Telephone Number	:	614-208-5230
Fax Number	:

Provider Business Practice Location Address
First Line	:	4311 RIDGEWOOD CENTER DR
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-5308
Country	:	US
Telephone Number	:	703-957-9322
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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