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NPI Code Detail

MEDICARE: RACHAEL ANN O'DONNELL LCSW, LADC

MEDICARE:   RACHAEL ANN O'DONNELL  LCSW, LADC
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
1101YA0400XAddiction (Substance Use Disorder) CounselorLC4075ME
21041C0700XClinical Social WorkerLC11662ME

General Provider Information

NPI Number : 1821158619
Entity Type Code : Individual
Provider Name (Legal Business Name) : RACHAEL ANN O'DONNELL LCSW, LADC
Provider Business Mailing Address
First Line : 88 STATE ST STE 201
Second Line :
City : GORHAM
State : ME
Zip : 04038-1015
Country : US
Telephone Number : 207-671-7414
Fax Number :
Provider Business Practice Location Address
First Line : 510 MAIN ST STE 112
Second Line :
City : GORHAM
State : ME
Zip : 04038-1339
Country : US
Telephone Number : 207-939-3295
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2006
Last Update Date : 10/16/2023

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Directions to “ RACHAEL ANN O'DONNELL LCSW, LADC” Practice Location

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