MEDICARE: MARY O'DONNELL LMHC

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	101YM0800X	Mental Health Counselor	MH 11449	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	64228401	OTHER	MD	CAREFIRST NONTAX ID

General Provider Information

NPI Number	:	1619089232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY O'DONNELL LMHC

Provider Business Mailing Address
First Line	:	705 WELLS RD STE 300
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-2982
Country	:	US
Telephone Number	:	904-282-6331
Fax Number	:	904-619-1080

Provider Business Practice Location Address
First Line	:	1865 LIME ST STE 100
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-4779
Country	:	US
Telephone Number	:	904-321-8400
Fax Number	:	904-321-8401

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/24/2022

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Directions to “ MARY O'DONNELL LMHC” Practice Location

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