Provider Demographics
NPI:1154523983
Name:O'DONNELL, ELLEN H (PHD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:H
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 MERRIMAC STREET, 5TH FLOOR
Mailing Address - Street 2:MASSACHUSETTS GENERAL HOSPITAL - LEAP PROGRAM
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-643-6017
Mailing Address - Fax:
Practice Address - Street 1:151 MERRIMAC STREET, 5TH FLOOR
Practice Address - Street 2:MASSACHUSETTS GENERAL HOSPITAL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-643-6017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPY 9080103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist