Provider Demographics
NPI:1861686701
Name:OSAWE, GENEVA (LCSW, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:GENEVA
Middle Name:
Last Name:OSAWE
Suffix:
Gender:F
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 BROADWAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-2687
Mailing Address - Country:US
Mailing Address - Phone:219-980-4330
Mailing Address - Fax:219-980-9119
Practice Address - Street 1:5825 BROADWAY
Practice Address - Street 2:SUITE D
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-2687
Practice Address - Country:US
Practice Address - Phone:219-980-4330
Practice Address - Fax:219-980-9119
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN340000011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9001137OtherBLUE CROSS & SHIELD IL
IN202580OtherMEDICARE-TYPE UNSPECIFIED