Provider Demographics
NPI:1043363674
Name:HORNYAK, CONNIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:
Last Name:HORNYAK
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 1:1538 BROOKHOLLOW DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5455
Mailing Address - Country:US
Mailing Address - Phone:714-751-7789
Mailing Address - Fax:714-751-7791
Practice Address - Street 1:1538 BROOKHOLLOW DR
Practice Address - Street 2:SUITE E
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5455
Practice Address - Country:US
Practice Address - Phone:714-751-7789
Practice Address - Fax:714-751-7791
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 70961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical