MEDICARE: MS. KAMAYANI ODEGARD LCSW-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	17921	MD

General Provider Information

NPI Number	:	1336613314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAMAYANI ODEGARD LCSW-C

Provider Business Mailing Address
First Line	:	8375 GROVE ANGLE RD
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6632
Country	:	US
Telephone Number	:	443-545-9603
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 W 36TH ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21211-2305
Country	:	US
Telephone Number	:	443-720-0090
Fax Number	:	855-212-5690

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2019
Last Update Date	:	01/26/2026

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