Healthcare Provider Details

I. General information

NPI: 1235051376
Provider Name (Legal Business Name): PATRICK MITCHELL ODELL SR. LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

996 JOHNSON RD
PALMYRA NY
14522-9755
US

IV. Provider business mailing address

996 JOHNSON RD
PALMYRA NY
14522-9755
US

V. Phone/Fax

Practice location:
  • Phone: 941-544-1720
  • Fax:
Mailing address:
  • Phone: 941-544-1720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number125629-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW26520
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: