Individual
EUGENE O'DONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
340 MONTAGE MOUNTAIN RD, MOOSIC, PA 18507
(570) 346-3686
(570) 558-6838
Mailing address
340 MONTAGE MOUNTAIN RD, MOOSIC, PA 18507-1782
(570) 346-3686
(570) 558-6838
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CW012903
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
292096Q9Z
MEDICARE
PA
Enumeration date
06/03/2006
Last updated
06/05/2018
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