Active NPI
Matthew Russell Osborne, BCBA
- Behavior Analyst
- Henrico, VA
National Provider Identifier
1104082254
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 0133000366
- Practice address
- 2351 Shellfish CT
Henrico, VA 23294-4916 - Phone
- (202) 450-7626
- NPI assigned
- Jul 29, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmentally Disabled Services Day Training Agency | 251C00000X | |||
| Behavior Analyst | 103K00000X | 0133000366 | VA | Primary |
Addresses
Primary practice location
2351 Shellfish CT
Henrico, VA 23294-4916
Mailing address
2351 Shellfish CT
Henrico, VA 23294-4916
Phone (202) 450-7626
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0133000366 | VA | MD | Behavioral Analyst |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lifespan Behavioral Services PLC | Behavior Analyst | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Developmentally Disabled Services Day Training Agency
- North Chesterfield, VA
- NPI 1326764283
Behavior Analyst
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1217289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1665532800000",
"number": "1104082254",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2351 SHELLFISH CT",
"city": "HENRICO",
"state": "VA",
"postal_code": "232944916",
"telephone_number": "202-450-7626"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2351 SHELLFISH CT",
"city": "HENRICO",
"state": "VA",
"postal_code": "232944916",
"telephone_number": "202-450-7626"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OSBORNE",
"first_name": "MATTHEW",
"middle_name": "RUSSELL",
"name_prefix": "Mr.",
"credential": "BCBA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-07-29",
"last_updated": "2022-10-12",
"certification_date": "2022-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "251C00000X",
"taxonomy_group": "",
"desc": "Day Training, Developmentally Disabled Services",
"state": null,
"license": null,
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "VA",
"license": "0133000366",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Henrico, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.