Active NPI
Page Odom, PSY.D
- Clinical Psychologist
- Odenton, MD
National Provider Identifier
1942463989
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 04143
- Practice address
- 8288 Telegraph Rd
Suite a
Odenton, MD 21113-1130 - Phone
- (410) 305-0158
- Fax
- (410) 305-0159
- NPI assigned
- Jul 9, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 04143 | MD | Primary |
Addresses
Primary practice location
8288 Telegraph Rd
Suite a
Odenton, MD 21113-1130
Mailing address
8288 Telegraph Rd
Suite a
Odenton, MD 21113-1130
Phone (410) 305-0158
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11833482 | Other | MD | CAQH |
Other names 1
- Dr. Lori Odom
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04143 | MD | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215561600000",
"number": "1942463989",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8288 TELEGRAPH RD",
"address_2": "SUITE A",
"city": "ODENTON",
"state": "MD",
"postal_code": "211131130",
"telephone_number": "410-305-0158",
"fax_number": "410-305-0159"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8288 TELEGRAPH RD",
"address_2": "SUITE A",
"city": "ODENTON",
"state": "MD",
"postal_code": "211131130",
"telephone_number": "410-305-0158",
"fax_number": "410-305-0159"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODOM",
"first_name": "PAGE",
"name_prefix": "Dr.",
"credential": "PSY.D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-07-09",
"last_updated": "2008-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "04143",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "11833482",
"state": "MD"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "LORI",
"last_name": "ODOM",
"prefix": "DR.",
"credential": "PSY.D",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Odenton, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.