Healthcare Provider Details

I. General information

NPI: 1104788397
Provider Name (Legal Business Name): ADELINE ODNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WASHINGTON ST STE 106
BRAINTREE MA
02184-4764
US

IV. Provider business mailing address

1090 MORTON ST
BOSTON MA
02126-2806
US

V. Phone/Fax

Practice location:
  • Phone: 617-471-8400
  • Fax:
Mailing address:
  • Phone: 617-319-5444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: