Healthcare Provider Details

I. General information

NPI: 1679733554
Provider Name (Legal Business Name): KEITH MICHAEL O'DONNELL LMFT, APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 RIDGEVIEW AVE
TRUMBULL CT
06611-1937
US

IV. Provider business mailing address

88 RIDGEVIEW AVE
TRUMBULL CT
06611-1937
US

V. Phone/Fax

Practice location:
  • Phone: 203-520-6111
  • Fax:
Mailing address:
  • Phone: 203-520-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number16107
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1455
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: