MEDICARE: KRISTINA ODUMES MSW, LCSW

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	1041C0700X	Clinical Social Worker	44SC05997500	NJ

General Provider Information

NPI Number	:	1932772241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA ODUMES MSW, LCSW

Provider Business Mailing Address
First Line	:	26 FIRESIDE CT
Second Line	:
City	:	WILLINGBORO
State	:	NJ
Zip	:	08046-2020
Country	:	US
Telephone Number	:	609-560-4722
Fax Number	:

Provider Business Practice Location Address
First Line	:	1255 ROUTE 70W
Second Line	:	SUITE 22N
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701
Country	:	US
Telephone Number	:	732-905-0327
Fax Number	:

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

Provider Enumeration Date	:	07/23/2021
Last Update Date	:	04/30/2024

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