=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396107884
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANDREA O'DONNELL, M.ED., LMHC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2016
-----------------------------------------------------
Last Update Date | 03/23/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 484 LOWELL ST SUITE D-6
-----------------------------------------------------
City | PEABODY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01960-7934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-566-9746
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 484 LOWELL ST SUITE D-6
-----------------------------------------------------
City | PEABODY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01960-7934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-566-9746
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED MENTAL HEALTH COUNSELOR
-----------------------------------------------------
Name | ANDREA O'DONNELL
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 978-566-9746
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 9500
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------