Provider Demographics
NPI:1487879458
Name:OSBORN, BETSY JANE (LCSW)
Entity type:Individual
Prefix:MS
First Name:BETSY
Middle Name:JANE
Last Name:OSBORN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:596 NEW LOUDON RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-4024
Mailing Address - Country:US
Mailing Address - Phone:518-782-9663
Mailing Address - Fax:518-783-4793
Practice Address - Street 1:596 NEW LOUDON RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-4024
Practice Address - Country:US
Practice Address - Phone:518-782-9663
Practice Address - Fax:518-783-4793
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO14555-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY54496BMedicare ID - Type UnspecifiedLCSW