Provider Demographics
NPI:1285781724
Name:OSGOOD, LYRESSA R (LICSW, LADC)
Entity type:Individual
Prefix:MS
First Name:LYRESSA
Middle Name:R
Last Name:OSGOOD
Suffix:
Gender:F
Credentials:LICSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 THACHER RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VT
Mailing Address - Zip Code:05477-9706
Mailing Address - Country:US
Mailing Address - Phone:802-399-8141
Mailing Address - Fax:
Practice Address - Street 1:67 THACHER RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VT
Practice Address - Zip Code:05477-9706
Practice Address - Country:US
Practice Address - Phone:802-399-8141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000343101YA0400X
VT089-00007521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1007914Medicaid