Provider Demographics
NPI:1407953052
Name:OSBORNE, ELANA RAE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELANA
Middle Name:RAE
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PINE HOLLOW
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002
Mailing Address - Country:US
Mailing Address - Phone:413-992-7023
Mailing Address - Fax:413-549-5998
Practice Address - Street 1:15 PINE HOLLOW
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002
Practice Address - Country:US
Practice Address - Phone:413-992-7023
Practice Address - Fax:413-549-5998
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4597103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist