Provider Demographics
NPI:1124077201
Name:OSBORN, ROBERT D (LCSW)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:OSBORN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 BURNING TREE RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-6804
Mailing Address - Country:US
Mailing Address - Phone:804-218-4382
Mailing Address - Fax:804-486-5290
Practice Address - Street 1:1421 BURNING TREE RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23231-6804
Practice Address - Country:US
Practice Address - Phone:804-218-4382
Practice Address - Fax:804-486-5290
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040020961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAOTH000Medicare UPIN
VA010832T07Medicare PIN