Healthcare Provider Details

I. General information

NPI: 1205590148
Provider Name (Legal Business Name): SHENAE OSBORN LMSW, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-120 QUEENS BLVD #1C
QUEENS NY
11374-1137
US

IV. Provider business mailing address

98120 QUEENS BLVD STE 1C
REGO PARK NY
11374-4414
US

V. Phone/Fax

Practice location:
  • Phone: 646-397-4183
  • Fax:
Mailing address:
  • Phone: 718-830-0246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number114044-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: