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NPI Code Detail

MEDICARE: MARIE MCCULLOUGH OSBORNE LCSW

MEDICARE: MARIE MCCULLOUGH OSBORNE LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker28189CA

General Provider Information

NPI Number : 1134234677
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIE MCCULLOUGH OSBORNE LCSW
Provider Business Mailing Address
First Line : 20735 PLACER HILLS RD
Second Line :
City : COLFAX
State : CA
Zip : 95713-9763
Country : US
Telephone Number : 530-710-0240
Fax Number :
Provider Business Practice Location Address
First Line : 11512 B AVE
Second Line :
City : AUBURN
State : CA
Zip : 95603-2605
Country : US
Telephone Number : 530-886-2937
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2006
Last Update Date : 01/02/2015

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