Provider Demographics
NPI:1710157698
Name:OSBORN, DEANNA (LCSW)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:OSBORN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 MAKIAN PL NW APT 10
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1073
Mailing Address - Country:US
Mailing Address - Phone:505-514-2650
Mailing Address - Fax:
Practice Address - Street 1:1300B E RIVER RD
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-7437
Practice Address - Country:US
Practice Address - Phone:505-312-0042
Practice Address - Fax:505-213-0066
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-85691041C0700X
NMM-05739104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM56184077Medicaid