MEDICARE: MR. JEAN CARLOS OSORIO LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	086403	NY

General Provider Information

NPI Number	:	1427207760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEAN CARLOS OSORIO LCSW

Provider Business Mailing Address
First Line	:	10814 72ND AVE STE 2
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-5301
Country	:	US
Telephone Number	:	347-361-8428
Fax Number	:

Provider Business Practice Location Address
First Line	:	10814 72ND AVE STE 2
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-5301
Country	:	US
Telephone Number	:	347-361-8428
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2008
Last Update Date	:	04/09/2021

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