Provider Demographics
NPI:1336241264
Name:OSBORNE, JAMES WILLIAM (LPC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WILLIAM
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1981 CHAMBERLAIN HWY
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06037-3908
Mailing Address - Country:US
Mailing Address - Phone:860-836-9527
Mailing Address - Fax:
Practice Address - Street 1:1981 CHAMBERLAIN HWY
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:CT
Practice Address - Zip Code:06037-3908
Practice Address - Country:US
Practice Address - Phone:860-836-9527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000346101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT297432OtherMHN
CTOSBOR0010OtherCOMP CARE