Provider Demographics
NPI:1831294826
Name:OSBORNE, MAUREEN LYNN (PH D)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:LYNN
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 E KING ST
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-3004
Mailing Address - Country:US
Mailing Address - Phone:610-647-8730
Mailing Address - Fax:610-647-8921
Practice Address - Street 1:412 E KING ST
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-3004
Practice Address - Country:US
Practice Address - Phone:610-647-8730
Practice Address - Fax:610-647-8921
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005173L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA603238Medicare ID - Type Unspecified