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General NPI Number Information
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NPI Number | 1679733554
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Entity Type | Individual
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Provider Name | KEITH MICHAEL O'DONNELL LMFT, APRN
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Gender | Male
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Dates
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Enumeration Date | 06/13/2008
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Last Update Date | 12/24/2025
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Provider Practice Location Address
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Address Line | 88 RIDGEVIEW AVE
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City | TRUMBULL
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State | CT
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Zip | 06611-1937
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Country | US
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Telephone | 203-520-6111
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Fax |
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Provider Business Mailing Address
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Address Line | 88 RIDGEVIEW AVE
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City | TRUMBULL
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State | CT
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Zip | 06611-1937
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Country | US
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Telephone | 203-520-6111
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1455
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 16107
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License Number State | CT
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