Healthcare Provider Details

I. General information

NPI: 1548440894
Provider Name (Legal Business Name): ALICE O'DONNELL LCSW.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2007
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5407 N CHARLES ST
BALTIMORE MD
21210-2024
US

IV. Provider business mailing address

406 ASH CIR
SEVERNA PARK MD
21146-2802
US

V. Phone/Fax

Practice location:
  • Phone: 410-433-2241
  • Fax: 410-433-1249
Mailing address:
  • Phone: 410-647-7417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR055581
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17989
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: