Provider Demographics
NPI:1194266437
Name:OSBORNE, KYLE (MSW)
Entity type:Individual
Prefix:MS
First Name:KYLE
Middle Name:
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1268 EDDY ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4535
Mailing Address - Country:US
Mailing Address - Phone:401-207-6888
Mailing Address - Fax:
Practice Address - Street 1:1268 EDDY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-4535
Practice Address - Country:US
Practice Address - Phone:401-207-6888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker