Provider Demographics
NPI:1285190058
Name:OSBORNE, NICOLE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 RITCHIE HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3935
Mailing Address - Country:US
Mailing Address - Phone:410-834-8394
Mailing Address - Fax:
Practice Address - Street 1:650 RITCHIE HWY STE 200
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3935
Practice Address - Country:US
Practice Address - Phone:410-834-8394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD168401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical