Provider Demographics
NPI:1093915415
Name:OSBORNE, BROOKE N (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:N
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4966 EL CAMINO REAL
Mailing Address - Street 2:SUITE 119
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1436
Mailing Address - Country:US
Mailing Address - Phone:650-229-8391
Mailing Address - Fax:
Practice Address - Street 1:4966 EL CAMINO REAL
Practice Address - Street 2:SUITE 119
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1436
Practice Address - Country:US
Practice Address - Phone:650-229-8391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25377103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11334OtherSFGH INTERNAL USE ONLY