Provider Demographics
NPI:1376608315
Name:OSBORNE, KENNETH (CASAC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BROWN ST
Mailing Address - Street 2:4TH FLOOR - CREDENTIALING
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-3617
Mailing Address - Country:US
Mailing Address - Phone:914-734-8858
Mailing Address - Fax:914-734-8745
Practice Address - Street 1:1037 MAIN ST
Practice Address - Street 2:HUDSON RIVER HEALTHCARE, INC.
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-2913
Practice Address - Country:US
Practice Address - Phone:914-734-8800
Practice Address - Fax:914-734-8745
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12988101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473038Medicaid