Provider Demographics
NPI:1861772238
Name:O'DONNELL, SAMANTHA LOUISE (MSW)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:LOUISE
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1291 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3803
Mailing Address - Country:US
Mailing Address - Phone:310-218-6554
Mailing Address - Fax:
Practice Address - Street 1:1291 W 13TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3803
Practice Address - Country:US
Practice Address - Phone:310-218-6554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical