Provider Demographics
NPI:1770622987
Name:ODONNELL, DEBRA (LCSW)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:
Last Name:ODONNELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 BEACON HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502
Mailing Address - Country:US
Mailing Address - Phone:914-693-7508
Mailing Address - Fax:914-693-7508
Practice Address - Street 1:765 N BROADWAY
Practice Address - Street 2:SUITE 16D
Practice Address - City:HASTINGS ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10706
Practice Address - Country:US
Practice Address - Phone:914-714-8030
Practice Address - Fax:914-693-7508
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR02874711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
184784POtherHIPPRIS
21476OtherCIGNA EL
P454057OtherOXFORD
179353OtherMHN
R028747OtherVYTRA
D0N037910OtherMED NY EL
21476OtherCIGNA EL