Provider Demographics
NPI:1851508865
Name:OSBERG, TIMOTHY MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:OSBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 HIDDEN OAKS CT
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-2575
Mailing Address - Country:US
Mailing Address - Phone:716-286-8524
Mailing Address - Fax:716-286-8254
Practice Address - Street 1:135 DEPAUL HALL
Practice Address - Street 2:NIAGARA UNIVERSITY - DEPT. OF PSYCHOLOGY
Practice Address - City:NIAGARA UNIVERSITY
Practice Address - State:NY
Practice Address - Zip Code:14109-2208
Practice Address - Country:US
Practice Address - Phone:716-286-8524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8018103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY259143Medicare ID - Type UnspecifiedPSYCHOLOGIST