Provider Demographics
NPI:1023031101
Name:MT LAUREL CTR FOR THE FAMILY
Entity Type:Organization
Organization Name:MT LAUREL CTR FOR THE FAMILY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:HORWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:856-722-9772
Mailing Address - Street 1:1155 ROUTE 73
Mailing Address - Street 2:RAMBLEWOOD CTR STE 12
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-2352
Mailing Address - Country:US
Mailing Address - Phone:856-722-9772
Mailing Address - Fax:856-722-9721
Practice Address - Street 1:1155 ROUTE 73
Practice Address - Street 2:RAMBLEWOOD CTR STE 12
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-2352
Practice Address - Country:US
Practice Address - Phone:856-722-9772
Practice Address - Fax:856-722-9721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37F100141400103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
636755Medicare ID - Type Unspecified