Provider Demographics
NPI:1154500908
Name:OSBORNE, JOHN CONNELL (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CONNELL
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 1:1280 BOULEVARD WAY
Mailing Address - Street 2:SUITE 212
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-1125
Mailing Address - Country:US
Mailing Address - Phone:925-932-0173
Mailing Address - Fax:
Practice Address - Street 1:1280 BOULEVARD WAY
Practice Address - Street 2:SUITE 212
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94595-1125
Practice Address - Country:US
Practice Address - Phone:925-932-0173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 87821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical