Healthcare Provider Details

I. General information

NPI: 1710157698
Provider Name (Legal Business Name): DEANNA OSBORN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300B E RIVER RD
BELEN NM
87002-7437
US

IV. Provider business mailing address

1135 MAKIAN PL NW APT 10
ALBUQUERQUE NM
87120-1073
US

V. Phone/Fax

Practice location:
  • Phone: 505-312-0042
  • Fax: 505-213-0066
Mailing address:
  • Phone: 505-514-2650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-8569
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: