Healthcare Provider Details

I. General information

NPI: 1699348284
Provider Name (Legal Business Name): OSBURT JOHN LORENZO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 07/05/2025
Certification Date: 07/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 DIPLOMACY DR
ANCHORAGE AK
99508-5919
US

IV. Provider business mailing address

4501 DIPLOMACY DR
ANCHORAGE AK
99508-5919
US

V. Phone/Fax

Practice location:
  • Phone: 907-729-5259
  • Fax: 907-729-3349
Mailing address:
  • Phone: 907-729-5259
  • Fax: 907-729-3349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number176387
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: