Healthcare Provider Details

I. General information

NPI: 1295811362
Provider Name (Legal Business Name): OSMARA REYES-OSORIO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 DEEP VALLEY DRIVE EAST #207
ROLLING HILLS ESTATES CA
90274
US

IV. Provider business mailing address

827 DEEP VALLEY DR STE 207
ROLLING HILLS ESTATES CA
90274-3654
US

V. Phone/Fax

Practice location:
  • Phone: 310-625-4406
  • Fax:
Mailing address:
  • Phone: 310-625-4406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW16271
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23157
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: