Provider Demographics
NPI:1386106110
Name:OSIECKI, ANDREA JEAN (MA, BCBC)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:JEAN
Last Name:OSIECKI
Suffix:
Gender:F
Credentials:MA, BCBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 VIOLADO
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-1651
Mailing Address - Country:US
Mailing Address - Phone:949-292-7998
Mailing Address - Fax:
Practice Address - Street 1:12395 LEWIS ST STE 102
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4698
Practice Address - Country:US
Practice Address - Phone:619-952-9095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health