Provider Demographics
NPI:1467419176
Name:OSTER, MICHAEL (LICSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:OSTER
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 DUFTON RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-2716
Mailing Address - Country:US
Mailing Address - Phone:978-474-0675
Mailing Address - Fax:
Practice Address - Street 1:184 PLEASANT VALLEY ST
Practice Address - Street 2:SUITE 204A (MAILBOX #16)
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5817
Practice Address - Country:US
Practice Address - Phone:978-474-0675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10327611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30423151Medicaid
MA04343177201Medicare UPIN
MAP07717Medicare UPIN
MA291362000Medicare UPIN
NH30423151Medicaid
MA20644160Medicare UPIN
MAOSP2157Medicare ID - Type Unspecified