Healthcare Provider Details

I. General information

NPI: 1003303777
Provider Name (Legal Business Name): MELISSA O'DONNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DERBY ST STE 206
HINGHAM MA
02043-3786
US

IV. Provider business mailing address

1 DERBY ST STE 206
HINGHAM MA
02043-3786
US

V. Phone/Fax

Practice location:
  • Phone: 781-236-3081
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10002763
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: