Provider Demographics
NPI:1306907647
Name:OSACHY, LORI (MSS, LCSW)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:OSACHY
Suffix:
Gender:F
Credentials:MSS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 LANDON AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8671
Mailing Address - Country:US
Mailing Address - Phone:904-737-3232
Mailing Address - Fax:866-631-9482
Practice Address - Street 1:1545 LANDON AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8671
Practice Address - Country:US
Practice Address - Phone:904-737-3232
Practice Address - Fax:904-396-4505
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW59161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ0616ZMedicare ID - Type Unspecified