| Organization Name: | ODONATA PSYCHOTHERAPY & RETREAT CENTER LLC |
| NPI Number: | 1902285414 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NANCY WILEY (OWNER) |
| Mailing Address: | 258 Main St Suite B - 4 Buzzards Bay |
| State: | MA US |
| Postal Code: | 025323222 |
| Phone Number: | 7742474939 |
| Fax Number: | 7743024419 |
| NPI Enumeration Date: | 05/29/2015 |
| NPI Last Update Date: | 01/01/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 118383 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |