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Organization
ODONATA PSYCHOTHERAPY & RETREAT CENTER LLC
Active
Organization
ODONATA PSYCHOTHERAPY & RETREAT CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY C WILEY LICSW (OWNER)
(774) 247-4939
Entity
Organization
Contact information
Practice address
121 MAIN ST, BUZZARDS BAY, MA 02532
(774) 247-4939
(774) 302-4419
Mailing address
121 MAIN ST, BUZZARDS BAY, MA 02532-3245
(774) 247-4939
(774) 302-4419
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
118383
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110101319A
—
MA
Enumeration date
05/29/2015
Last updated
08/15/2018
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