Provider Demographics
NPI:1053586693
Name:ODOM, PATRICIA N (MED, MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:N
Last Name:ODOM
Suffix:
Gender:F
Credentials:MED, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-1023
Mailing Address - Country:US
Mailing Address - Phone:203-561-6825
Mailing Address - Fax:
Practice Address - Street 1:252 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-1023
Practice Address - Country:US
Practice Address - Phone:203-561-6825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0126561041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1309161Medicaid