Provider Demographics
NPI:1427299114
Name:OSORIO, MARCO F
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:F
Last Name:OSORIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 6TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-2021
Mailing Address - Country:US
Mailing Address - Phone:928-777-3280
Mailing Address - Fax:
Practice Address - Street 1:1310 CARLOCK DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-6427
Practice Address - Country:US
Practice Address - Phone:928-550-2455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor