Healthcare Provider Details

I. General information

NPI: 1851474738
Provider Name (Legal Business Name): GREGORY L ODONNELL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E WILLOW AVE METROPOLITAN FAMILY SERVICES
WHEATON IL
60145
US

IV. Provider business mailing address

19W181 18TH PLACE
LOMBARD IL
60148
US

V. Phone/Fax

Practice location:
  • Phone: 630-784-4810
  • Fax: 630-682-5276
Mailing address:
  • Phone: 847-946-5838
  • Fax: 630-682-5276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: