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NPI Code Detail

MEDICARE: BRENDAN ODONNEL LMSW

MEDICARE: BRENDAN ODONNEL LMSW
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
11041C0700XClinical Social Worker6801112466MI

General Provider Information

NPI Number : 1942862123
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENDAN ODONNEL LMSW
Provider Business Mailing Address
First Line : 1458 W TRUMBULL RD
Second Line :
City : MAPLE CITY
State : MI
Zip : 49664-9642
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1844 OAK HOLLOW DR STE B
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49686-5924
Country : US
Telephone Number : 231-714-0282
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2019
Last Update Date : 05/26/2022

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Directions to “ BRENDAN ODONNEL LMSW” Practice Location

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