Provider Demographics
NPI:1679372460
Name:TIMMERMAN MCLEAN, ODESSA IANTHIE
Entity type:Individual
Prefix:
First Name:ODESSA
Middle Name:IANTHIE
Last Name:TIMMERMAN MCLEAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:893 WEST ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-3359
Mailing Address - Country:US
Mailing Address - Phone:413-559-5458
Mailing Address - Fax:
Practice Address - Street 1:893 WEST ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-3359
Practice Address - Country:US
Practice Address - Phone:413-559-5458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALCSW228996104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker