Individual provider Active NPI

Carolyn Sue O'Dell, LCSW

  • Clinical Social Worker
  • Cumberland, MD
National Provider Identifier
1851965719
Registry record updated Sep 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
21149 Issued in MD
Practice address
610 Memorial Ave
Cumberland, MD 21502-3767
Phone
(301) 707-0744
NPI assigned
May 16, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 24, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 21149 MD
Mental Health Counselor 101YM0800X
Clinical Social Worker 1041C0700X 21149 MD Primary

Addresses

Primary practice location

610 Memorial Ave
Cumberland, MD 21502-3767

Mailing address

36 Rackin on Rd
Grantsville, MD 21536-3251
Phone (301) 707-0744

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221217000013 MD Practitioner - Clinical Social Worker 6406225259 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Privia Medical Group, LLCGroup PAC ID 4385682061, 1,522 clinicians

Practice addresses (Care Compare)

133 Defense Hwy
Annapolis, MD 21401-7015

16 Greenmeadow Dr
Suite 302
Timonium, MD 21093-3200
Phone (443) 449-5604

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group, LLC CurrentSince Oct 3, 2022 Accepting new patients
Privia Medical Group, LLC CurrentSince Oct 3, 2022 Accepting new patients

Locations

133 Defense Hwy
Ste 112
Annapolis, MD 21401
Phone (410) 573-0140

950 N Glebe Rd
Ste 700
Arlington, VA 22203
Phone (484) 228-1065

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663977600000",
    "number": "1851965719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36 RACKIN ON RD",
            "city": "GRANTSVILLE",
            "state": "MD",
            "postal_code": "215363251",
            "telephone_number": "301-707-0744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 MEMORIAL AVE",
            "city": "CUMBERLAND",
            "state": "MD",
            "postal_code": "215023767",
            "telephone_number": "301-707-0744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'DELL",
        "first_name": "CAROLYN",
        "middle_name": "SUE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-05-16",
        "last_updated": "2022-09-24",
        "certification_date": "2022-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MD",
            "license": "21149",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "21149",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cumberland, MD

Sources for this page

Verify at the official NPI Registry.