Provider Demographics
NPI:1003964313
Name:HORN, LISBETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISBETH
Middle Name:
Last Name:HORN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BRYSON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1922
Mailing Address - Country:US
Mailing Address - Phone:718-442-1636
Mailing Address - Fax:718-442-1636
Practice Address - Street 1:201 BRYSON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1922
Practice Address - Country:US
Practice Address - Phone:718-442-1636
Practice Address - Fax:718-442-1636
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR041856-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY454018OtherVALUE OPTIONS PIN
NMP1016677OtherOXFORD PIN
NY7407345OtherGHI PIN
NY7407345OtherGHI PIN