Healthcare Provider Details

I. General information

NPI: 1497692313
Provider Name (Legal Business Name): LANDON A OSBORN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 DIXWELL AVE
NEW HAVEN CT
06511-3470
US

IV. Provider business mailing address

965 N HIGH ST
EAST HAVEN CT
06512-1020
US

V. Phone/Fax

Practice location:
  • Phone: 203-809-6108
  • Fax:
Mailing address:
  • Phone: 203-809-6108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number015756
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: