Provider Demographics
NPI:1609412444
Name:OSBORNE, DANA MARIE (CRPA-P)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MARIE
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:CRPA-P
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:MARIE
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:79 GLENRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-4523
Mailing Address - Country:US
Mailing Address - Phone:518-747-8001
Mailing Address - Fax:
Practice Address - Street 1:55 ELM ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3670
Practice Address - Country:US
Practice Address - Phone:518-793-7273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4018101YA0400X
NY175T00000X
NY37554101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01420800Medicaid