Healthcare Provider Details

I. General information

NPI: 1154500908
Provider Name (Legal Business Name): JOHN CONNELL OSBORNE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 BOULEVARD WAY SUITE 212
WALNUT CREEK CA
94595-1125
US

IV. Provider business mailing address

1280 BOULEVARD WAY SUITE 212
WALNUT CREEK CA
94595-1125
US

V. Phone/Fax

Practice location:
  • Phone: 925-932-0173
  • Fax:
Mailing address:
  • Phone: 925-932-0173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 8782
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: