Provider Demographics
NPI:1043793292
Name:OSBORNE, CURTIS D (LCSW)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:D
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60678-1032
Mailing Address - Country:US
Mailing Address - Phone:630-717-2258
Mailing Address - Fax:
Practice Address - Street 1:600 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CASEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62232-1329
Practice Address - Country:US
Practice Address - Phone:618-345-3970
Practice Address - Fax:618-345-4398
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0183141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical