Provider Demographics
NPI:1083774012
Name:OSGOOD, EDMUND W (LCSWR)
Entity Type:Individual
Prefix:MR
First Name:EDMUND
Middle Name:W
Last Name:OSGOOD
Suffix:
Gender:M
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-2715
Mailing Address - Country:US
Mailing Address - Phone:607-936-1771
Mailing Address - Fax:607-936-2648
Practice Address - Street 1:77 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2715
Practice Address - Country:US
Practice Address - Phone:607-936-1771
Practice Address - Fax:607-936-2648
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0527541104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC0098Medicare PIN