Basic Information
| Provider Information | |||||||||
| NPI: | 1841376613 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OSBORNE | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18 SCHULTZ PL | ||||||||
| Address2: | |||||||||
| City: | KENSINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060372122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608285190 | ||||||||
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| Practice Location | |||||||||
| Address1: | 896 ASYLUM AVE | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061051901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605228241 | ||||||||
| FaxNumber: | 8605271919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 002646 | CT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.