Provider Demographics
NPI:1548440894
Name:O'DONNELL, ALICE (LCSW-C)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 ASH CIR
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-2802
Mailing Address - Country:US
Mailing Address - Phone:410-647-7417
Mailing Address - Fax:
Practice Address - Street 1:5407 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2024
Practice Address - Country:US
Practice Address - Phone:410-433-2241
Practice Address - Fax:410-433-1249
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-04
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0555811041C0700X
MD179891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical