Provider Demographics
NPI:1265311260
Name:O'DONNELL, KEVIN HUGH (CAGS, NCSP)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:HUGH
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:CAGS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8908 RIGGS RD FL CENTER3
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-1632
Mailing Address - Country:US
Mailing Address - Phone:301-985-1700
Mailing Address - Fax:
Practice Address - Street 1:8908 RIGGS RD FL CENTER3
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-1632
Practice Address - Country:US
Practice Address - Phone:301-985-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16-3823103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist