Provider Demographics
NPI:1073583993
Name:HORBERG, BENJAMIN (LCSW)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:HORBERG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5222 FM 1960 RD W
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-4423
Mailing Address - Country:US
Mailing Address - Phone:708-712-5520
Mailing Address - Fax:
Practice Address - Street 1:5222 FM 1960 RD W
Practice Address - Street 2:STE 218
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-4408
Practice Address - Country:US
Practice Address - Phone:773-404-0160
Practice Address - Fax:773-404-9876
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX646841041C0700X
AZLCSW-134381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL941740Medicare ID - Type Unspecified