Healthcare Provider Details

I. General information

NPI: 1134978810
Provider Name (Legal Business Name): JORDAN C OSBORNE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2024
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MATTHEWS ST STE 102
GOSHEN NY
10924-1995
US

IV. Provider business mailing address

205 SOMERSET BAY DR APT 4
GLEN BURNIE MD
21061-6488
US

V. Phone/Fax

Practice location:
  • Phone: 845-843-6400
  • Fax: 845-421-6804
Mailing address:
  • Phone: 845-843-6400
  • Fax: 845-421-6804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18-P116952-02
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: